Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1991
The effects of a 16-N-homopiperidino analogue of vecuronium on neuromuscular transmission in anaesthetized cats, pigs, dogs and monkeys, and in isolated preparations.
Org 9991, a 16-N-homopiperidinium substituted vecuronium analogue, has been tested for neuromuscular blocking activity in anaesthetized cats, pigs, dogs and monkeys, and in isolated nerve-muscle preparations. Org 9991 exhibited non-depolarizing neuromuscular blocking activity of the competitive type, being reversible by neostigmine and showing no endplate channel blocking action in isolated preparations. ⋯ The potency and time course of action of Org 9991 remained similar in all four species: i.e. 90% block at ca 200-300 micrograms kg-1; onset time ca 1.2-1.9 min; duration 90% ca 4.5-8.9 min. This study suggests that 16-N-homopiperidinium analogues of vecuronium may provide leads in the quest for a potent non-depolarizing replacement for suxamethonium.
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Acta Anaesthesiol Scand · Jan 1991
Randomized Controlled Trial Clinical TrialInjection pain, intubating conditions and cardiovascular changes following induction of anaesthesia with propofol alone or in combination with alfentanil.
In a double-blind study, propofol (P) 2-2.5 mg.kg-1 preceded by saline (Sal) or alfentanil (A) 20-30 micrograms.kg-1 was used for anaesthetic induction in 59 young patients of ASA physical class I or II, premedicated with oxycodone 0.1 mg.kg-1 and atropine 0.01 mg.kg-1 i.m. The patients were randomly allocated to one of the four groups: Group 1 Sal + P2.5, Group 2 A20 + P2.5, Group 3 A30 + P2.5 and Group 4 A30 + P2. Pain on injection of propofol occurred in 67, 36 and 7% of the patients in the Sal + P2.5, A20 + P2.5 and A30 + P2 groups, respectively, but not at all in the A30 + P2.5 group. ⋯ The other groups did not differ significantly from the Sal + P2.5 group. After injection of propofol, both systolic and diastolic arterial pressures decreased significantly in all other groups, with the exception of diastolic pressure in the Sal + P2.5 group, whereas heart rate did not differ from the control level. After intubation, systolic arterial pressure increased statistically significantly in the Sal + P2.5 and A30 + P2 groups and diastolic arterial pressure in all other groups with the exception of the A30 + P2.5 group when compared with the corresponding preceding values.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Jan 1991
Long-term intrathecal morphine and bupivacaine in "refractory" cancer pain. I. Results from the first series of 52 patients.
Neither epidural (EDA) or intrathecal (IT) morphine nor EDA opiate + bupivacaine provides acceptable relief of some types of cancer pain, e.g. pain originating from mucocutaneous ulcers, deafferentation pain, continuous and intermittent visceral and ischaemic pain, and that occurring with body movement as a result of a fracture. To improve pain relief in such conditions, we gave combinations of morphine and bupivacaine through open IT-catheters to 52 patients with "refractory", severe (VAS 7-10 out of 10), complex cancer pain (Edmonton Stage-3), for periods of 1-305 (median = 23) days. The efficacy of the treatment was estimated from: 1) daily dosage (intraspinal and total opiates, and intraspinal bupivacaine), and 2) scores of non-opiate analgesic and sedative consumption, gait and daily activities, and amount and pattern of sleep. ⋯ The IT-treatment significantly decreased the total (all routes) opiate consumption and significantly improved sleep, gait and daily activities. For the whole period of observation (6 months), the IT-treatment was assessed as adequate in 3.8%, good in 23.1%, very good in 59.6% and excellent in 13.5% of the cases. Adverse effects of the IT-bupivacaine (paraesthesiae, paresis, gait impairment, urinary retention, anal sphincter disturbances and orthostatic hypotension) did not occur with doses of 2.5-3.0 mg/h (approx. 60-70 mg/day).
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Acta Anaesthesiol Scand · Jan 1991
Randomized Controlled Trial Clinical TrialEffects of oral clonidine premedication and postoperative i.v. infusion on haemodynamic and adrenergic responses during recovery from anaesthesia.
The effects of clonidine, a central alpha 2-adrenoreceptor agonist, on haemodynamic and catecholamine changes were assessed during emergence from anaesthesia, a period which is associated with increased sympathetic nervous discharge, hypertension and tachycardia. According to a double-blind randomized design, 32 patients received either clonidine, preoperatively given by oral route (3.5 micrograms.kg-1) and postoperatively by i.v. infusion (0.3 microgram.kg-1.h-1), or a placebo. Perioperative management was similar in both groups. ⋯ Only at the latest measurement (6 h after core temperature reached 37 degrees C) did clonidine elicit significant effects. The values during clonidine infusion compared to placebo were at this time: mean blood pressure (73 +/- 10 vs 86 +/- 13 mmHg) (9.7 +/- 1.3 vs 11.5 +/- 1.7 kPa), heart rate (71 +/- 6 vs 93 +/- 13 beats.min-1) and plasma norepinephrine levels (240 +/- 224 vs 451 +/- 111 pg.ml-1). Our results suggest that: 1) preoperative clonidine may improve the haemodynamic profile associated with anaesthetic discontinuation, but 2) i.v. infusion (0.3 microgram.kg-1.h-1) did not prolong this effect during the early postoperative period in the face of the sympathetic nervous discharge of recovery.
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Acta Anaesthesiol Scand · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialTransnasal butorphanol: a new method for pain relief in post-cesarean section pain.
This study was undertaken to evaluate the efficacy and the safety of transnasal butorphanol (TNB) compared to intravenous butorphanol (IVB) in 186 patients experiencing moderate to severe post-cesarean section pain. Patients were randomly assigned to five groups in a double-blind fashion: Group I (n = 37) received 2 mg IVB, Group II (n = 38) 2 mg TNB, Group III (n = 36) 1 mg TNB followed by a repeat dose of 1 mg TNB at 60 min, Group IV (n = 38) 0.5 mg TNB followed by a repeat dose of 0.5 mg at 60 min, and Group V (n = 37) received placebo. All administrations were double dummy. ⋯ There were no incidences of nasal mucosa irritation, or cardiovascular or respiratory depression. It is concluded that transnasal butorphanol represents a safe and effective alternative to injectable butorphanol for post-cesarean section pain and offers a better and longer duration of analgesia compared to IV butorphanol. The optimum dose seems to be 2 mg TN butorphanol and it is tolerated better when divided into 1 mg increments, given 1 h apart.