Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Facilitation of rapid-sequence intubation with large-dose vecuronium with or without priming.
To determine the effect of priming on the intubation and onset times of vecuronium 0.3 mg/kg. ⋯ Seventy-five percent to 85% neuromuscular block of the adductor pollicis, required for atraumatic tracheal intubation, developed in 80 seconds or less when vecuronium 0.3 mg/kg was administered in divided doses and in 140 seconds or less when it was injected as a single bolus dose. Clinical duration of vecuronium 0.3 mg/kg is long and unpredictable, and reversal of residual neuromuscular block may require larger doses of anticholinesterases. It is recommended that an intubating dose of vecuronium 0.3 mg/kg be used only in patients undergoing long surgical procedures that require prolonged postanesthetic mechanical ventilation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neonatal acid-base status following general anesthesia for emergency abdominal delivery with halothane or isoflurane.
To determine whether halothane or isoflurane as anesthesia for emergency abdominal delivery is associated with better fetal acid-base parameters. ⋯ There is no difference in the frequency or severity of acidosis associated with isoflurane or halothane when used for general anesthesia for emergency abdominal delivery of a distressed fetus.
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Case Reports
Mechanical ventilation of a patient with decreased lung compliance and tracheal dilatation.
Tracheal injury resulting from tracheal intubation is common. Injuries vary in type and severity, from mucosal sloughing to tracheal stenosis and fistula formation. ⋯ To reduce the tracheal dilatation but maintain adequate ventilation and continuous positive airway pressure, we substituted a longer double-cuff tracheotomy appliance and used an automatic intermittent cuff inflator. The problems related to the design of modern tracheal tube cuffs are discussed.
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Endoesophageal prostheses are sometimes used in palliative therapy of esophageal carcinoma. Placement or subsequent manipulation of these devices may require general anesthesia, and these anesthetics are fraught with potential complications, both from the patient's illness and from the prosthesis itself. The two patients in our report presented anesthetic challenges, including acute upper airway obstruction occurring outside the operating theater and management of malignant tracheoesophageal fistula.
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Review Comparative Study
Clinical pharmacology of mivacurium chloride: a review.
Mivacurium chloride (Mivacron) is a new benzylisoquinolinium choline-like diester neuromuscular blocking drug with an onset of action at equipotent doses that is comparable to atracurium and vecuronium but slower than succinylcholine. Its clinical duration (injection-25% recovery and injection-95% recovery) is twice that of succinylcholine but one-half to one-third that of atracurium and vecuronium. Mivacurium is easy to use as a continuous infusion and when used this way its recovery characteristics are unchanged. ⋯ In these patients and those with acquired deficiencies, mivacurium should not be used. The duration of action in elderly patients is comparable to that in the young, while in prerenal transplant patients, its duration is prolonged by about 50%, and in prehepatic transplant patients, duration of block is increased threefold. Mivacurium possesses the advantages of short duration, unchanged recovery characteristics following infusions (without phase II block or tachyphylaxis), and precise control.(ABSTRACT TRUNCATED AT 250 WORDS)