Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 1981
Comparative StudyComparison of physostigmine and neostigmine for antagonism of neuromuscular block.
The ability of physostigmine alone and in combination with neostigmine to reverse d-tubocurarine-induced neuromuscular block was evaluated in surgical patients. The relaxation was maintained at a level of 90% twitch suppression during balanced anesthesia, and antagonism was attempted with physostigmine 1.5 mg x 3; neostigmine 0.5 mg x 3; neostigmine 1.0 mg x 3; or with a combination of physostigmine 0.75 mg and neostigmine 0.5 mg x 3. The measured parameters included the twitch force or EMG amplitude of the adductor pollicis brevis muscle after supramaximal 0.1 Hz stimulation and fading of these responses after repetitive 2 and 50 Hz stimuli. ⋯ The addition of physostigmine to a subeffective dose of neostigmine resulted in antagonism comparable to that seen in other groups. The clinical antagonism was satisfactory in all patients receiving physostigmine. The divergence of relaxation-indicating parameters (twitch responses and fades) after physostigmine suggests dissimilar modes of action of two antagonists at the neuromuscular junction.
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Acta Anaesthesiol Scand · Oct 1981
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of epidural morphine and epidural bupivacaine for postoperative pain relief.
In 32 patients subjected to total hip replacement, postoperative pain relief was achieved by random treatment with either 5 mg of morphine in 10 ml of saline (n = 15) or 6-8 ml of 0.5% bupivacaine with epinephrine (n = 17), both drugs administered by the lumbar epidural route. In an additional group of 10 patients, post-traumatic thoracic or post-operative abdominal pain was relieved first by 4-6 ml of 0.5% bupivacaine with epinephrine and subsequently by 5 mg of morphine in 10 ml of saline, both drugs being administered by the thoracic epidural route. The duration of analgesia was significantly longer, on average, with morphine (28 h) than with bupivacaine (4.3 h) when the drugs were given by the lumbar route. ⋯ Plasma concentrations of morphine were not detectable 8 h after injection, though the patients still had pain relief. One case of delayed severe respiratory depression occurred 6 h after morphine injection via the thoracic route. Epidural morphine analgesia should therefore be reserved for patients in whom continual surveillance is possible, at least until more is known about the pharmacokinetics of narcotics in the epidural and subarachnoid space.
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Acta Anaesthesiol Scand · Oct 1981
Randomized Controlled Trial Clinical TrialEffects of precurarization on the blood pressure and heart rate changes induced by suxamethonium facilitated laryngoscopy and intubation.
The effects of precurarization on blood pressure and heart rate increases during laryngoscopy and intubation were studied in 60 surgical patients, who were randomly allocated to four groups, receiving as a pretreatment d-tubocurarine (0.05 mg/kg), alcuronium (0.03 mk/kg) , pancuronium (0.008 mg/kg) or saline in a double-blind fashion. d-Tubocurarine and alcuronium pretreatments seemed to attenuate the blood pressure increase during laryngoscopy and intubation under suxamethonium. Moreover, d-tubocurarine pretreatment protected effectively against high blood-pressure increases. Heart-rate increases were of the same magnitude in all the pretreated groups. d-Tubocurarine pretreatment abolished suxamethonium-induced fasciculations completely, whereas alcuronium pretreatment gave protection in 93% and pancuronium pretreatment in 43% of patients.
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Acta Anaesthesiol Scand · Oct 1981
Comparative StudyCaudal block for post-operative pain relief in children after genital operations. A comparison between bupivacaine and morphine.
Twenty-two children formed the basis for a controlled study of the effect and duration of the postoperatively applied caudal block on postoperative pain after genital operations. The purpose of the study was to compare the effect and duration of bupivacaine and morphine. Ten children (Group I, outpatients) underwent circumcision and 12 children (Group II, inpatients) underwent correction of hypospadias. ⋯ Outpatients were discharged after 4-5 h, and the caudal blocks with both bupivacaine and morphine were then still effective. In inpatients, the duration of pain relief was significantly longer using morphine (range 610-2195 min) than using bupivacaine (range 245-515 min). There were no complications of the caudal blocks.