Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 1983
Comparative StudyCardiac arrhythmias in non-intubated children during adenoidectomy. A comparison between enflurane and halothane anaesthesia.
The incidence of cardiac arrhythmias, heart rate, blood pressure, capillary perfusion and end-tidal CO2 tension were studied in 167 healthy children 1-12 years of age undergoing adenoidectomy (n = 82) and myringotomy (n = 85) during enflurane and halothane anaesthesia. The incidence of cardiac arrhythmias was significantly lower during myringotomy than during adenoidectomy. In children undergoing adenoidectomy the incidence of arrhythmias was 38.9% during enflurane anaesthesia and 86.6% during halothane anaesthesia (P less than 0.001). ⋯ Heart rate was increased by about 40% at the onset of ventricular arrhythmias. The heart rate remained unchanged with enflurane anaesthesia during surgery, which may reflect a decreased sympathomimetic activity. It is suggested that the low incidence of ventricular arrhythmias during enflurane anaesthesia may be explained by the combination of a reduced sympathomimetic activity and a lowered susceptibility of the myocardium to the actions of endogenous catecholamines.
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Acta Anaesthesiol Scand · Feb 1983
Case ReportsBupivacaine cardiotoxicity in a patient with renal failure.
Bradycardia and hypotension were the first major signs of toxicity from a 250 mg bupivacaine axillary brachial plexus block experienced by a patient with chronic renal failure, who had an anion gap acidosis and hyperkalaemia. Without these metabolic abnormalities, this patient received four similar blocks: three were without incident and one was complicated by seizure. Acidosis and/or hyperkalaemia in man appears to increase the myocardial susceptibility to bupivacaine toxicity into the range of arterial concentrations of the drug normally produced by plexus blocks, even in the absence of drug-induced cerebral toxicity, seizures and hypoxia.
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Acta Anaesthesiol Scand · Dec 1982
Clinical Trial Controlled Clinical TrialEMLA--a eutectic mixture of local anaesthetics for topical anaesthesia.
A new topical anaesthetic formulation, EMLA, consisting of a eutectic mixture of the two local anaesthetics, prilocaine and lidocaine, was used in an attempt to reduce the pain associated with venous cannulation in children. The formulation of the local anaesthetic cream yields a high concentration (approximately 80%) of active substance compared with previous formulations (approximately 20%). ⋯ Stimulus of C fibre endings in the subcutaneous tissue and/or the vascular wall seems to be the mechanism behind the slight to moderate discomfort experienced by about one third of the children treated with EMLA. Local side effects of EMLA were negligible.
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Acta Anaesthesiol Scand · Dec 1982
Comparative StudyAttenuation of circulatory response to laryngoscopy and tracheal intubation: a comparison of two methods of topical anaesthesia.
Circulatory responses to laryngoscopy and endotracheal intubation were compared between three groups of patients, two of which were subjected to a procedure of topical anaesthesia before induction of general anaesthesia. Topical anaesthesia, achieved with either a lidocaine dose aerosol or by gargling with viscous lidocaine, attenuated the magnitude of the pressor response to laryngoscopy and intubation but had no effect on the heart rate response. Lidocaine aerosol had some advantages over viscous lidocaine; these were the significantly smaller haemodynamic response to the local anaesthetic procedure itself and probably shorter duration of the circulatory changes produced by intubation. It is concluded that both of these simple methods are relatively ineffective in preventing haemodynamic changes associated with laryngoscopy and intubation and should probably be combined with another preventive method.
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Acta Anaesthesiol Scand · Dec 1982
Comparative StudyA comparison of atropine and glycopyrrolate in anaesthetic practice.
The two anticholinergics, atropine and glycopyrrolate, were used for premedication and as an adjunct to reversal of residual neuromuscular block in a double-blind study. Glycopyrrolate, being about twice as potent as atropine in the clinical situation, was used in half the dosage of atropine. When used for premedication, no difference was found between the drugs concerning patients complaining of dry mouth, but more patients in the glycopyrrolate group had a gastric juice pH greater than 2.5 compared to the atropine group (not statistically different). ⋯ More patients in the atropine group had "excessive" oropharyngeal secretions (more than 2 ml) when extubated (P less than 0.05). The postoperative assessment showed little difference in the two groups, apart from a lower incidence of nausea and vomiting in the atropine group (not statistically different). The study shows that the use of glycopyrrolate was associated with a more stable cardiovascular system, fewer arrhythmias and superior control of oropharyngeal secretions at the time of reversal.