British journal of anaesthesia
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Comparative Study
Ventilatory effects during and after continuous infusion of fentanyl or alfentanil.
The opioid drugs fentanyl and alfentanil were infused at a constant rate as supplements to nitrous oxide in oxygen anaesthesia throughout the period of surgery. These infusions were continued into the period after operation for 1 h after the discontinuation of anaesthesia. Continuous infusion of alfentanil 20 micrograms kg-1 h-1 and fentanyl 3 micrograms kg-1 h-1 resulted in depression of the carbon dioxide response curve with a lesser effect on frequency and minute ventilation. One hour after discontinuing the infusions the degree of ventilatory depression was only marginally less with fentanyl, but considerably less with alfentanil, reflecting the shorter terminal half-life of that drug.
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Conditions for endotracheal intubation provided by different dose regimens of atracurium 0.4 mg kg-1 and 0.5 mg kg-1 were studied and compared with each other and with suxamethonium 1.0 mg kg-1. Intubation was attempted at 2.5, 2 min and 1.5 min following a bolus dose of atracurium, and 1 min following suxamethonium. ⋯ Atracurium, when administered 5 min following recovery from a suxamethonium-induced block, had a significantly faster onset of neuromuscular blockade (P less than 0.01) than the onset observed following atracurium alone. Administration of atracurium 0.42 mg kg-1 3 min after an initial dose of 0.08 mg kg-1 of the drug produced a significantly more rapid onset of block when compared with a bolus dose of 0.5 mg kg-1 (P less than 0.02).
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The effects of halothane and of prior administration of suxamethonium on atracurium neuromuscular blockade have been investigated. Halothane potentiated the intensity of block produced by atracurium 0.1 or 0.15 mg kg-1. Duration of block was prolonged (27%) by halothane with a small dose of atracurium (0.15 mg kg-1) and was also prolonged (29%) with larger doses of atracurium (0.4 mg kg-1). Prior suxamethonium 1 mg kg-1 increased the intensity of block after atracurium 0.15 mg kg-1 from 52% (control) to 84%, but caused minimal change in duration of atracurium blockade.
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Randomized Controlled Trial Clinical Trial
Intranasal administration of nitroglycerine attenuates the pressor response to laryngoscopy and intubation of the trachea.
The intranasal administration of nitroglycerine (NTG) was undertaken in 35 adult female patients 1 min before the induction of anaesthesia. A control group consisting of 32 patients did not receive NTG. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before the induction of anaesthesia and at 0, 3, and 5 min after tracheal intubation. ⋯ SAP did increase significantly in the control group. HR was increased in both groups immediately after intubation (P less than 0.001 and P less than 0.001 respectively). NTG administered intranasally is a safe, simple and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.