Journal of clinical anesthesia
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Less than a decade ago, the only nondepolarizing neuromuscular blocking drugs available to the anesthetist were traditional long-acting drugs such as pancuronium and d-tubocurarine. The revolution that began 10 years ago in our use of relaxants promises to continue unabated into the next decade. Changes in our clinical use of these drugs will be sparked not just by the introduction of new drugs but also by a greater understanding of the pharmacokinetic/pharmacodynamic principles that govern onset and recovery.
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To determine the effect of reperfusion of the grafted liver on transcranial Doppler blood flow velocity in the middle cerebral artery in humans during orthotopic liver transplantation. ⋯ MCAVm increased with reperfusion of the grafted liver. These data suggest that multiple factors--including hypercarbia, lactic acidosis, or multiple vasoactive substances released by the grafted liver--may contribute to the observed increases in MCAVm, Vs, and PI.
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Case Reports
The BAAM and endotrol endotracheal tube for blind oral intubation. Beck Airway Air Flow Monitor.
Blind oral intubation in a spontaneously breathing patient can be facilitated with a combination of two devices used mainly for nasotracheal intubation, the BAAM (Beck Airway Air Flow Monitor, Great Plains Ballistics, Lubbock, TX) and the Endotrol endotracheal tube (Mallinckrodt Critical Care, Inc., St. Louis, MO). ⋯ In the successful approach we describe, the tube was passed through the oral cavity and pharynx in a blind fashion, using the BAAM's whistling sound for guidance and the plastic ring of the Endotrol tube to help positioning. This equipment combination may be useful in certain difficult intubation situations.
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Randomized Controlled Trial Clinical Trial
The effect of ondansetron on atracurium-induced neuromuscular blockade.
To determine whether treatment with ondansetron, a new antiemetic drug, affects nondepolarizing neuromuscular blockade. ⋯ Ondansetron is an antiemetic drug that can be used in the perioperative period without concern for potentiation of nondepolarizing neuromuscular blockade, change in atracurium maintenance dose, or change in rate of neostigmine-induced recovery from neuromuscular blockade with atracurium.