British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Recovery characteristics following antagonism of atracurium with neostigmine or edrophonium.
The evoked reversal characteristics of atracurium were studied in 21 patients using edrophonium or neostigmine and a train-of-four pattern of stimulation. Reversal of residual atracurium -induced neuromuscular blockade was significantly more rapid using edrophonium compared with neostigmine. The ratio of the fourth twitch in the train-of-four to the first twitch--the T4 ratio--was significantly greater when the first twitch (T1) had recovered to 75% of control T1, using edrophonium compared with neostigmine. A T4 ratio of 0.5 was confirmed to be compatible with the reliable and safe reversal of atracurium -induced neuromuscular blockade.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of ketamine anaesthesia on the metabolic response to pelvic surgery.
The effects of ketamine anaesthesia on the metabolic and endocrine response to pelvic surgery were investigated, and compared with results obtained in a control group of patients anaesthetized with thiopentone and halothane. Ketamine anaesthesia before the onset of surgery was associated with a significant increase in blood glucose and plasma cortisol concentrations, and in heart rate. However, when surgery was established there were no metabolic, endocrine or haemodynamic differences between ketamine and halothane anaesthesia. We conclude that ketamine does not exacerbate the metabolic response to surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison between the continuous infusion of vecuronium and the intermittent administration of pancuronium and vecuronium.
The neuromuscular blocking effects of repeated bolus injections of pancuronium, or vecuronium, and of the continuous infusion of vecuronium have been compared in 36 patients by means of evoked twitch tension. Groups I and II received a loading dose (0.075 mg kg-1) of pancuronium or vecuronium, respectively, followed by 0.015-mg kg-1 maintenance doses when twitch tension had recovered to 25% of control. Group III received a 0.075-mg kg-1 loading dose of vecuronium plus a continuous infusion (commenced simultaneously) delivering 0.075 mg kg-1 h-1. ⋯ These values did not correlate with the total dose of vecuronium infused. For clinical practice, the suggested loading dose is 1.5 times the ED90 (= 0.07 mg kg-1) followed by an infusion of the same dose per hour. The infusion should be started within 10 min of the injection of the loading dose.
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Evidence of central nervous system toxicity was noted in two patients undergoing extradural analgesia for Caesarean section. There was no cardiovascular depression and both patients recovered rapidly. The patients had received total doses of bupivacaine plain solution of 357.5 mg and 356.25 mg, respectively and the relationship of these to the clinical signs of bupivacaine toxicity is discussed.