British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Dose-response relationships and neuromuscular blocking effects of vecuronium pancuronium during ketamine anaesthesia.
The dose-response curves of vecuronium and pancuronium were compared during ketamine anaesthesia in 60 patients (ASA I). The relationship between the probit transformed depression of twitch height and the logarithm of the dose was analysed by linear regression. Vecuronium was found to be 1.2 times more potent than pancuronium. ⋯ The time to 25% recovery of twitch height following vecuronium 73 microgram kg-1 was 22.2 min compared with 66.6 min following pancuronium 99 microgram kg-1. Following supplementary doses of vecuronium, a statistically significant increase in duration of action was seen following the fourth and fifth doses. Reversal time of vecuronium to a train-of-four ratio of 0.7 was significantly shorter than that of pancuronium (8.3 min and 13.6 min, respectively).
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Comparative Study Clinical Trial Controlled Clinical Trial
Rate of onset of good intubating conditions, respiratory depression and hand muscle paralysis after vecuronium.
The development of neuromuscular blockade of the adductor pollicis muscle following vecuronium 0.1, 0.15 and 0.2 mg kg-1, was compared with the development of intubating conditions and respiratory paralysis. From this relationship, the optimal time after injection required for ideal tracheal intubation was calculated for the three doses of vecuronium. The effects of these doses of vecuronium on the onset, the duration of action and rate of recovery were studied. ⋯ Suxamethonium 1.5 mg kg-1 (preceded by gallamine 20 mg 2 min earlier), produced excellent conditions in under 1 min. Hypopnoea occurred when the peripheral neuromuscular blockade was about 20-40% established with vecuronium or 50% established with pancuronium. Increasing the dose of vecuronium from 0.1 mg kg-1 to 0.2 mg kg-1 prolonged significantly the duration of action (from 21 to 48 min) but did not shorten significantly the onset time nor prolong the rate of recovery.
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Comparative Study
Fetal-neonatal status following caesarean section for fetal distress.
Fetal biochemical and neonatal clinical data were compiled in 126 emergency Caesarean sections performed for fetal distress. The choice of anaesthetic technique was determined by the wishes of the mother. General anaesthesia was administered to 71 parturients and regional analgesia to 55 (subarachnoid block 33, extension of extradural block 22). ⋯ Umbilical artery blood pH values were higher than the last scalp capillary blood pH values in 63% of the general anaesthesia and in 80% of the regional analgesia cases. Umbilical vein and artery blood-gas and pH data were similar in the two anaesthesia groups, but 1-min Apgar scores were significantly better following regional analgesia. Despite the presence of fetal distress, subarachnoid blockade was a most suitable method of anaesthesia in experienced hands.
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Comparative Study
Comparison of vecuronium, atracurium and tubocurarine in normal patients and in patients with no renal function.
Vecuronium (initial dose 0.1 mg kg-1; incremental doses 0.04 mg kg-1) was given to 21 normal and 21 anephric patients. There were no gross differences between the two groups in the effect or in the duration of action of either initial or incremental doses, except in two anephric patients who were resistant to the agent. Reversal with neostigmine was satisfactory. ⋯ However, in anephric patients, except in the resistant patients, the behaviour of vecuronium was similar to that of atracurium (26 patients). A comparison with an initial dose of tubocurarine 0.5 mg kg-1 given to 20 anephric patients and tubocurarine 0.6 mg kg-1 given to 21 normal and 20 anephric patients showed tubocurarine to be longer acting and considerably less predictable. This was particularly so in the anephric group, in which its action sometimes persisted after neostigmine had been given.
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The ventilation and carbon dioxide elimination of each lung, and pulmonary arterial pressure, were studied in 17 patients during the early phases of anaesthesia for pulmonary surgery. The patients were ventilated mechanically to moderate hypocapnia. Expired tidal volume and carbon dioxide elimination rate of the lung to be operated on, and of the other lung, were similar in the supine position. ⋯ The regression equation was delta (VD/VT) (%) = 0.7 - 0.83 X delta MPAP (mmHg). It was concluded that variations in pulmonary arterial pressure during surgical stimulation may significantly affect the pattern of carbon dioxide elimination in the lungs. However, there was no evidence that these effects were important clinically.