British journal of anaesthesia
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After extradural blockade failed to extend sufficiently for elective Caesarean section, spinal anaesthesia was performed using 1.6 ml of hyperbaric 0.5% bupivacaine solution in 8% glucose (Marcain Heavy). The patient rapidly developed sensory blockade to the level of T2, and became distressed and dyspnoeic. ⋯ Despite i.v. ephedrine and fluid loading, severe hypotension occurred, which responded subsequently to further doses of ephedrine and infusion of colloid. A healthy infant was delivered by Caesarean section.
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Randomized Controlled Trial Clinical Trial
Low-dose intrathecal diamorphine analgesia following major orthopaedic surgery.
In a randomized double-blind study we examined the effect of adding diamorphine 0.25 mg and 0.5 mg to intrathecal bupivacaine anaesthesia for major orthopaedic surgery. Duration of postoperative analgesia was considerably greater in patients given either doses of intrathecal diamorphine than in a control group of patients given bupivacaine alone (P less than 0.001). However, there was no significant difference between the two diamorphine doses (0.25 mg and 0.5 mg), each providing prolonged analgesia (10.8 and 9.9 h, respectively). Although there was no evidence of late respiratory depression, the frequency of adverse effects, in particular urinary retention, nausea and vomiting, was high in both groups receiving intrathecal diamorphine.
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Randomized Controlled Trial Clinical Trial
Recovery of neuromuscular function after infusion or intermittent bolus doses of atracurium or vecuronium.
Neuromuscular block and postoperative recovery of grip strength and peak expiratory flow (PEF) were compared in patients receiving atracurium or vecuronium administered by continuous infusion or intermittent bolus doses. The same total dose of atracurium (0.92-0.98 mg kg-1) or vecuronium (0.16-0.18 mg kg-1) was given by both methods. A similar degree of neuromuscular block was attained in all groups. ⋯ This was most marked following infusion of vecuronium (less than 50%). Grip strength recovered in all groups in 30-60 min. PEF was still significantly less than control value at 90 min in all groups receiving neuromuscular blocking drugs.
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Randomized Controlled Trial Clinical Trial
Influence of suxamethonium on the action of subsequently administered vecuronium or pancuronium.
The effects of suxamethonium were studied on the onset time and duration of action of vecuronium or pancuronium in 45 adult patients anaesthetized with halothane and nitrous oxide. After an intubating dose of suxamethonium, the force of the evoked twitch returned to a value greater than control. The onset of the reduction in force produced by subsequent administration of vecuronium or pancuronium was faster and recovery slower. This potentiating effect of suxamethonium persisted for at least 2 h.
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We present a new pattern of nerve stimulation--double burst stimulation (DBS)--to detect residual neuromuscular block manually. The DBS consists of two short lasting, 50-Hz tetanic stimuli or bursts separated by a 750-ms interval. The response to this pattern of stimulation is two single separated muscle contractions of which the second is less than the first during nondepolarizing neuromuscular blockade. ⋯ The DBS with three impulses in each burst (DBS3,3) was considered to be the most sensitive and the least painful and thus most suitable for clinical use. The degree of fade in TOF and DBS3,3 was almost identical at any level of blockade (correlation coefficient 0.96), and the major post-DBS3,3 effect was a depression of the first twitch in TOF lasting less than 15 s. It is concluded that the DBS is more sensitive than the TOF in manual detection of residual block.