Anaesthesia
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This study was conducted to investigate the effect of voluntary tetanus on the recovery from neuromuscular block produced by a nondepolarising drug, vecuronium, in the isolated forearm. We have studied the recovery indices and train of four fade at different levels of recovery following vecuronium in both isolated forearms simultaneously, in six sets of experiments. In one hand the volunteer performed a maximum contraction of his thumb repeatedly at fixed intervals. ⋯ The train-of-four fade also showed a sustained reduction in the isolated forearm which underwent voluntary tetanus. During the later phase of recovery the train-of-four fade showed significant difference statistically (p < 0.01). The findings of this study supports the hypothesis that more rapid recovery associated with voluntary tetanus is due to a reduction in the presynaptic block thus resulting in an increased rate of transmitter release.
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A 52-year-old Caucasian male underwent heterotopic cardiac transplant and subsequently developed a ventricular tachycardia in his native heart. The arrhythmia was successfully treated by cardioversion, despite an increased rate associated with induction of anaesthesia with propofol. The method of synchronised cardioversion is described and a possible hypothesis for the acceleration of ventricular tachycardia following induction is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural infusions for nulliparous women in labour. A randomised double-blind comparison of fentanyl/bupivacaine and sufentanil/bupivacaine.
Sixty nulliparous women received epidural infusions in labour of 0.0625% bupivacaine containing either 2.5 micrograms.ml-1 of fentanyl or 0.25 micrograms.ml-1 of sufentanil, each starting at 12 ml.h-1. The duration of each stage of labour did not differ significantly between the groups nor did the mode of delivery. The quality of analgesia in the first and second stages of labour and at delivery was similar in the two groups and there were no significant differences in the bupivacaine dose requirements. ⋯ There were no significant differences in Apgar scores, umbilical cord blood pH levels or neurologic and adaptive capacity scores at 2 or 24 h. Satisfaction with first and second stage analgesia was high with no differences between the groups. There were no significant differences in the incidence of postnatal symptoms with 52% of women reporting perineal pain and 45% localised backache.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between mivacurium and suxamethonium in children.
The neuromuscular effects of mivacurium were compared with those of suxamethonium in 69 children (aged 2-12 years), during nitrous oxide, oxygen and halothane anaesthesia in a randomised open study. Neuromuscular block was monitored by measuring the acceleration of the thumb caused by contraction of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve at the wrist using an Accelograph. End-tidal carbon dioxide was maintained at about 4 kPa in both groups. ⋯ The range of maximum block was similar for both drugs. The average time to reach maximum block was 143 s for mivacurium and 56 s for suxamethonium. Intubating conditions were similar in the two groups.
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We report our experience of 58 patients undergoing awake fibreoptic intubation for cervical spine surgery. Topical anaesthesia was administered using a 'spray as you go' technique. The tracheas of 57 patients were intubated successfully. ⋯ The minimum mean arterial oxygen saturation was 92.9% (SEM 1.1). There was no relationship between the time taken to intubation and the episodes of desaturation or the grade of laryngeal visibility at direct laryngoscopy. This method of producing topical anaesthesia for awake fibreoptic intubation is recommended.