Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cisatricurium in the orbicularis oculi muscle. Comparisn of the neuromuscular action of cisatracurium and atracurium in the orbicularis oculi muscle and the adductor pollicis muscle].
Muscle relaxants have different pharmacodynamic profiles in various muscles. Therefore, results obtained for one muscle cannot be extrapolated to other muscles. In the adductor pollicis muscle cisatracurium exerts a pharmacodynamic profile comparable to atracurium, despite the known difference in onset time. However, studies evaluating the neuromuscular effect of cisatracurium in different muscles are lacking. Accordingly, this study compares the pharmacodynamic profile of cisatracurium and atracurium in the orbicularis oculi muscle (OO) - which shows a neuromuscular course similar to the diaphragm and the laryngeal muscles - and the adductor pollicis muscle (AP). ⋯ Cisatracurium shows a dose-dependent shorter onset time in the OO than in the AP. This is consistent with the current view that the onset of non-depolarizing neuromuscular blockers is more rapid in the OO than in the AP. However, at least a dose of 3x ED(95) of cisatracurium was necessary to show a difference in onset time between both muscles. In contrast, atracurium is reported to lead to a significantly shorter onset of neuromuscular block in the OO following 2x the ED(95). The more rapid recovery of T(1) to 10% of its control in all three groups in the OO is due to the relative resistance of this muscle to muscle relaxants.
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A treatment procedure requires the consent of the patient, but this is legally effective only if he is capable of giving his consent and can be informed accordingly. Because of demographic development and the progress of medicine, the number of patients who are not able to give their consent is increasing. In practice, we make do with the presumed consent of the patient or, for procedures that can wait, with the consent of legitimate family members. An initiative action is suggested by physicians and hospitals that should reduce this gray zone and the forensic risks drastically.
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Comparative Study Clinical Trial
[Effects of long-term opioid therapy on psychomotor function in patients with cancer pain or non-malignant pain].
Despite increasing use of oral opioids in cancer and non cancer pain, little is known about the effects of long-term opioid therapy on psychomotor performance. This study was designed to investigate the effects of long-term opioid analgesia on attention and reaction time in cancer pain and in non-malignant pain. ⋯ Long-term opioid therapy produces a slight (non significant) impairment of psychomotor performance in patients with cancer pain or non-malignant chronic pain. These effects become significantly more pronounced with increasing age and in patients with cancer pain, indicating a higher susceptibility of the elderly towards opioids. These results indicate that, particularly in older patients receiving long-term opioid for cancer oder non-cancer pain, careful evaluation of their effects on psychomotor function is necessary in order to estimate patient's ability to perform his daily activities. However, since opioid effects were only minimal in the non-elderly other factors like basic disease, opioid dose, physical condition and age seem to be of greater importance than the effects of opioids per se.
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A 72-year-old patient received 0.1 mg morphine by the intrathecal route and 2 x 1.5 mg midazolam as adjuvant therapy. Severe respiratory depression and somnolence supervened 3.5 h later, which lasted over the next 24 h and necessitated intubation and mechanical ventilation. Continuous administration of >6 mg naloxone to antagonize the supposed effect of the morphine had no effect. ⋯ For the time being, especially in the case of elderly patients, we recommend that strict indications are adhered to when intrathecal administration of morphine is considered and that less than 0.1 mg morphine is given. Diazepines should be avoided. Respiration should be monitored for quite some time.