British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Antagonism of moderate degrees of vecuronium-induced neuromuscular block by small doses of neostigmine.
We have studied the influence of a reduced dose of neostigmine on recovery from vecuronium-induced neuromuscular block in 26 adult patients, using electromyographic responses to train-of-four (TOF) stimulation. Neostigmine 10, 20 or 40 micrograms kg-1 was administered when the first response had recovered spontaneously to 5-10% or 40-50% of control. Antagonism was accepted as adequate when the first response reached 90% of control and the TOF ratio reached 0.7. ⋯ Block produced by neostigmine was not observed. The pattern of recovery of the single response and the TOF ratio was not altered by neostigmine in the range of doses studied. We suggest that the dose of neostigmine should not be reduced below 40 micrograms kg-1 even when all responses of the TOF are present.
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We evaluated the use of an inexpensive trans-illuminating light wand for tracheal intubation. Expertise in its use was acquired quickly, thereby providing successful per-oral intubation in all patients who were able to open the mouth, irrespective of the view obtained of the epiglottis and larynx.
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Diltiazem inhibited and antagonized the abnormal contractures induced by halothane, caffeine and potassium chloride in isolated skeletal muscle from pigs susceptible to malignant hyperpyrexia (MHS). Contractile responses to caffeine and electrical stimulation also were suppressed by diltiazem in control tissue. Similar effects were obtained in the presence of dantrolene. ⋯ In MHS and control preparations detubulated by glycerol, diltiazem did not inhibit or antagonize caffeine-induced contractures while dantrolene did. Diltiazem seems to modify contractile responses at the level of the transverse tubule membrane by inhibiting the inward flow of extracellular Ca2+, while dantrolene inhibits Ca2+ release directly from the sarcoplasmic reticulum. Ca2+ influx through transverse tubules may be important in the aetiology of the MH syndrome.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of mivacurium and suxamethonium administered by bolus and infusion.
Mivacurium chloride is a new, short-acting nondepolarizing neuromuscular blocking agent presently undergoing clinical evaluation. The neuromuscular effects of mivacurium and suxamethonium given by bolus and infusion were compared in adult patients during nitrous oxide-oxygen-opioid anaesthesia. Neuromuscular block was monitored by recording the compound electromyogram of the adductor pollicis muscle resulting from supramaximal train-of-four stimuli applied to the ulnar nerve. ⋯ There was a significant negative correlation between recovery to T5 and infusion rate for mivacurium and for suxamethonium. It was equally easy to titrate the infusion rate to the desired degree of block in each group. The recovery index (T25-T75) after the infusion stopped was similar in patients who received mivacurium and those who received suxamethonium.