British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Atracurium and vecuronium: effect of dose on the time of onset.
The time intervals measured from the administration of either atracurium or vecuronium to maximum or 95% neuromuscular blockade (Tmax) were compared in 70 patients using the evoked compound action potential of the adductor pollicis muscle. Equipotent doses, calculated from the relationship between dose and response for both drugs obtained in an earlier study, were compared. The doses of atracurium and vecuronium ranged from 0.135 to 0.5 mg kg-1 and from 0.02 to 0.1 mg kg-1, respectively. ⋯ Similarly, no change in Tmax occurred at doses of vecuronium in the range 0.02-0.05 mg kg-1 and 0.06-0.1 mg kg-1. Tmax changed significantly in the dose ranges atracurium 0.2-0.24 mg kg-1 and vecuronium 0.05-0.06 mg kg-1. There was no significant difference in Tmax when equipotent doses of atracurium and vecuronium were compared.
-
This report describes the management of a poor risk Nepalese patient (active pulmonary tuberculosis, haemoglobin concentration 4.6 g dl-1, weight 28.5 kg) requiring emergency Caesarean section for fetal distress. Subarachnoid blockade (0.5% bupivacaine plain 3.5 ml) was satisfactory; blood loss was around 400 ml and was replaced with Haemaccel and lactated Ringer's solution (blood was not available). Although unresponsive at birth, the child had an Apgar score of 10 at 15 min.
-
Comparative Study
Static v. dynamic tests in the in vitro diagnosis of malignant hyperthermia susceptibility.
In vitro contracture tests, in which muscle specimens are exposed to halothane or caffeine are, at present, the only generally accepted screening methods for the diagnosis of susceptibility to malignant hyperthermia (MHS). Static tests (performed with the muscle held at constant length) are used more commonly although, in addition, some MH investigation units use dynamic tests, in which the length of the specimen is varied. ⋯ The dynamic halothane test was more sensitive in discriminating between MHS and MH negative (MHN) individuals than the static halothane test. However, the dynamic caffeine test was less sensitive at discriminating between MHS and MHN individuals, and nothing is to be gained by including it in the investigation.
-
An artificial patient capable of spontaneous and artificial ventilation has been used for bench testing of the Ohmeda CPU-1. This ventilator has an extensive capacity for interaction with the spontaneous breathing of the patient, and provides a wide variety of operating modes. These include spontaneous breathing with or without continuous positive pressure, volume-cycled and pressure-cycled artificial ventilation, with or without positive end-expiratory pressure or synchronization. ⋯ The synchronization permits adaptation of the ventilator to spontaneous respiration according to a wide range of harmonics. In any mode, artificial ventilation is initiated if spontaneous respiration is inadequate. The mandatory minute volume mode is based on a complicated program of a cautious nature which reacts instantly to inadequate spontaneous breathing, but is slow to discontinue artificial ventilation.