Anaesthesia
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Randomized Controlled Trial Clinical Trial
Effects of magnesium sulphate on suxamethonium-induced complications during rapid-sequence induction of anaesthesia.
Twenty patients were studied in a double-blind manner to investigate whether magnesium sulphate, when given during a rapid-sequence induction of anaesthesia, lessens the side effects caused by suxamethonium. Patients were randomly allocated to two groups; equal volumes of either magnesium sulphate (40 mg.kg-1) or saline were given during rapid-sequence induction of anaesthesia, after thiopentone but before the administration of suxamethonium (1.5 mg.kg-1). The changes in the serum potassium concentration, the degree of muscle fasciculations and the presence of postoperative myalgia were recorded. ⋯ Magnesium did not clinically prolong muscle relaxation. There was no difference between the groups in the incidence of myalgia after surgery (one patient in each group). Since no significant increase in the serum potassium concentration was demonstrated, no assessment could be made of the effect of magnesium sulphate on the serum potassium concentration after administration of suxamethonium.
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Paravertebral analgesia is highly effective in blocking unilateral afferent input from the trunk, but its bilateral use does not appear to have been described. Eight patients undergoing major abdominal vascular surgery had pre-operative bilateral paravertebral catheters inserted. A dose of 25 ml of bupivacaine 0.5% divided between the two catheters provided the basis of an effective intra-operative analgesic regimen which was continued postoperatively by infusion of bupivacaine for 4 days. ⋯ Three patients were not admitted to the intensive care unit, where mean stays for the group was 10 h (range 0-24 h) and mean hospital stay was 10 days (range 7-14). There were no additional demands made on the nursing staff and no postoperative pain-related complications occurred. We conclude that bilateral paravertebral analgesia, as part of a balanced analgesic technique, is an alternative method of providing effective afferent blockage for major abdominal surgery.
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Randomized Controlled Trial Clinical Trial
The influence of isoflurane on a continuous infusion of mivacurium.
Sixty surgical patients were studied to evaluate the neuromuscular effects of mivacurium 0.15 mg.kg-1 (2 x ED95) for tracheal intubation. After intubation the patients were randomly allocated to receive alfentanil with either propofol (starting with 9 mg.kg-1 h-1, reducing to 6 mg.kg-1 h-1 after 20 min) or isoflurane (0.5% end-tidal). In addition, all the patients were given a continuous infusion of mivacurium 10 micrograms.kg-1 min-1 after tracheal intubation which was adjusted to maintain 90% depression of T1. ⋯ Tracheal intubation was completed 232 (155) s after administration of the relaxant and intubating conditions were graded as 'excellent' or 'good' in 56 patients. Although the mean (SD) mivacurium infusion rate for maintaining T1 at 10% was higher in the propofol group, 4.8 (2.1) compared with 4.4 (2.0) micrograms.kg-1 min-1 in the isoflurane group, this was not significantly different (p > 0.05). The mean (SD) recovery index was prolonged in the isoflurane patients, 757 (508)s, compared to those receiving propofol, 466 (219)s (p < 0.05).
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Biography Historical Article Classical Article
The supine hypotensive syndrome. 1960.