Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Randomized Controlled Trial Clinical Trial
Cardiovascular effects of non-depolarizing neuromuscular blockers in patients with aortic valve disease.
To compare haemodynamic responses associated with equipotent doses of neuromuscular blockers and high-dose fentanyl (50 micrograms.kg-1), 40 patients with aortic valve stenosis (AS) and 20 patients with aortic insufficiency (AI) were randomized to four study groups to receive the following: (1) pancuronium 0.12 mg.kg-1, (2) vecuronium 0.12 mg.kg-1, (3) atracurium 0.4 mg.kg-1, or (4) pancuronium-metocurine mixture (0.4 mg + 1.6 mg/ml): 1 ml/10 kg). Neuromuscular blockers were injected at the same time with the fentanyl; haemodynamics were recorded with the patients awake (baseline), at two minutes post-induction, and at two and five minutes after intubation. In patients with AS, pancuronium increased heart rate more than vecuronium or atracurium; heart rates were also higher with the pancuronium-metocurine mixture than with vecuronium. ⋯ Atracurium caused unexplained elevations in diastolic and mean arterial pressures which were significant when compared to vecuronium (p less than 0.01). These results in increases in PCWP; mean PA pressures and CVP were also increased. These effects of atracurium inpatients with Al need further evaluation.
-
The effect of age on the onset and duration of action of a d-tubocurarine (DTC) neuromuscular blockade with and without pancuronium priming in children was examined. Sixty ASA physical status I or II patients in three age ranges (0-1 yr, 1-3 yr and 3-10 yr) were anaesthetized with thiopentone, halothane and nitrous oxide. Each patient received either a single paralyzing dose of DTC 0.4 mg.kg-1, or DTC 0.36 mg.kg-1 preceded three minutes earlier by pancuronium 0.007 mg.kg-1. ⋯ Time to ten per cent spontaneous recovery after single dose DTC was shorter in older individuals (r = 0.40, p less than 0.05), being 36.4 +/- 5.1 min in infants 0-1 yr, 30.6 +/- 4.6 min (1-3 yr), and 24.0 +/- 2.7 min (3-10 yr). Priming with pancuronium accelerated the onset significantly in all age groups with 90 per cent T1 depression occurring at 0.7 +/- 0.1 min (0-1 yr), 0.9 +/- 0.1 min (1-3 yr), and 2.1 +/- 0.6 min (3-10 yr). However, priming delayed recovery, especially in infants.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Randomized Controlled Trial Clinical Trial
Femoral nerve block with bupivacaine 0.25 per cent for postoperative analgesia after open knee surgery.
An assessment was made, in a randomised double-blind fashion, of the pain relief afforded by femoral nerve block (FNB) performed at the end of ligament reconstruction of the knee, using 0.25 per cent bupivacaine in ten patients, and normal saline in ten patients. All patients commenced "continuous passive motion" (CPM) of the operated knee after arrival in the Recovery Room. The postoperative analgesic requirement, both for intravenous fentanyl in the Recovery Room, and intramuscular and oral analgesia on the ward, was then studied. ⋯ The bupivacaine group also required significantly less intravenous fentanyl in the Recovery Room. On the ward, there was no difference between the two groups in the total dose of intramuscular meperidine given in the first 12 hours postoperatively. We conclude that femoral nerve block is a useful adjunct in pain management after ligament reconstruction of the knee, especially in the early postoperative period, but does not decrease the total intramuscular dose of analgesia in the first 12 postoperative hours.