British journal of anaesthesia
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The plasma concentration of hepatic glutathione S-transferase (GST) was measured in matched groups of patients who received halothane, enflurane or isoflurane anaesthesia for elective minor surgery. The GST concentrations increased significantly at 3 h after anaesthesia in patients who received halothane or enflurane, but not in patients who were given isoflurane. ⋯ The small but significant increases in GST concentrations in patients receiving halothane or enflurane suggests an impairment of hepatocellular integrity following the administration of these anaesthetics. In contrast, isoflurane anaesthesia did not appear to be associated with this effect.
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Case Reports
Muscle relaxation in patients with Duchenne's muscular dystrophy. Use of vecuronium in two patients.
Cumulative 50% and 90% neuromuscular blocking doses of vecuronium were determined in two 4-yr-old boys with Duchenne's muscular dystrophy. Vecuronium 20 micrograms kg-1 was required for 50% twitch depression in both patients. The 90% blocking doses were 43 and 57 micrograms kg-1. ⋯ Thus, the titration of the individual neuromuscular blocking dose with the aid of a nerve stimulator is mandatory. During a previous anaesthetic, cardiac arrest and acute rhabdomyolysis had occurred in one patient. The substitution of suxamethonium by vecuronium, or probably any other non-depolarizing myoneural blocking drug of intermediate or short duration of action, may help to avoid this complication.
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Twelve cats were assigned equally to two groups, one with normal, and the other with artificially-increased intracranial pressure. When suxamethonium was administered to these animals, the intracranial pressure increased in both groups, irrespective of their baseline intracranial pressure. When the same dose of suxamethonium was administered after pretreatment with thiopentone in both groups of animals, the intracranial pressure again increased from the control values.
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Anterior fontanelle pressure responses to tracheal intubation in the awake and anaesthetized infant.
In order to define the changes in intracranial pressure which occur during tracheal intubation in young infants, a Ladd transducer was used to monitor anterior fontanelle pressure (AFP) non-invasively in awake (group 1, n = 14) and anaesthetized (group 2, n = 10) infants during intubation of the trachea. Heart rate and systolic arterial pressure were also recorded. In quiet, undisturbed infants, AFP (mean +/- SEM) was similar in groups 1 (9.6 +/- 0.5 mm Hg) and 2 (8.7 +/- 0.8 mm Hg); with crying, AFP increased significantly in both groups. ⋯ Neither heart rate nor systolic arterial pressure changed significantly in either group during laryngoscopy--when compared with measurements in the quiet state. It was concluded that AFP increases significantly during intubation and during crying in the infant. The response to intubation is only partially attenuated by the prior administration of general anaesthesia.