British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of neuromuscular block in the diaphragm and hand after administration of tubocurarine, pancuronium and alcuronium.
The onset and offset of neuromuscular block in the diaphragm and in the adductor pollicis muscle were recorded using unilateral supramaximal stimulation of phrenic and ulnar nerves. Thirty patients were allocated randomly to receive tubocurarine 0.4-0.5 mg kg-1, pancuronium 0.07-0.08 mg kg-1 or alcuronium 0.2-0.3 mg kg-1. ⋯ There was a correlation between the time of spontaneous reappearance of twitch in the diaphragm and in the adductor pollicis only in the patients who received pancuronium (r = 0.97, P less than 0.05 for reappearance of the first twitch of the train-of-four of each muscle). The duration of paralysis in the diaphragm was less than 5 min in five patients who received tubocurarine and in one who received alcuronium; this corresponded to a period of paralysis in the adductor pollicis muscle of more than 25 min in each case.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesia following extradural and i.m. pethidine in post-caesarean section patients.
The onset, quality and duration of analgesia following extradural pethidine 50 mg and i.m. pethidine 100 mg was assessed in 30 postoperative patients who had undergone Caesarean section under extradural anaesthesia. Saline and pethidine were given in a randomized, double-blind fashion using simultaneous extradural and i.m. injections. Extradural pethidine provided superior analgesia, of quicker onset but similar duration, and both treatments were associated with a low incidence of side effects.
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Comparative Study
Memory function after i.v. midazolam or inhalation of isoflurane for sedation during dental surgery.
Memory function was assessed with a recognition memory test in 40 dental patients before and after sedation with i.v. midazolam or inhalation of isoflurane. The two groups were comparable, but there was a significant impairment of memory (P less than 0.001) at the time of discharge for both words and faces after midazolam, but not after isoflurane.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative hypoxaemia: comparison of extradural, i.m. and patient-controlled opioid analgesia.
Arterial oxygen saturation (SaO2) was analysed continuously before and for 24 h after lower abdominal surgery in 30 patients breathing air using one of three postoperative analgesic regimens: i.v. diamorphine using a patient-controlled analgesia system (PCAS), extradural diamorphine or i.m. morphine. Hypoxaemia was defined as SaO2 less than 94% for more than 6 min h-1. Before operation there was no difference between the three analgesia groups assessed by the duration when SaO2 was less than 94%. ⋯ Before operation, the unstable group with hypoxaemia spent longer at less than 94% SaO2 (mean 4.8 min h-1, 95% CL 1.0-8.6 min h-1) than the stable group (mean 0.4 min h-1, 95% CL 0.17-0.61 min h-1) and this was a predictor of postoperative hypoxaemia. Hypoxaemia occurred in all analgesia groups, but extradural diamorphine tended to cause longer periods. Some patients at risk of postoperative hypoxaemia may be predicted by preoperative monitoring of SaO2 although extradural diamorphine boluses were associated with hypoxaemia in patients with normal preoperative values.
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Randomized Controlled Trial Clinical Trial
Edrophonium antagonism of atracurium during enflurane anaesthesia.
To determine the influence of enflurane on the ability of edrophonium to antagonize atracurium block, dose-response curves were constructed for edrophonium in the presence of 0%, 1% and 2% enflurane, and for 2% enflurane discontinued at the time of administration of edrophonium. One hundred ASA Physical Status I or II patients (four groups of 25), selected randomly and undergoing elective surgery, received atracurium 0.5 mg kg-1, with thiopentone, nitrous oxide and enflurane. Supplementary doses of fentanyl were given if needed. ⋯ Monitoring was continued for at least 10 min, at which time T1 and TOF ratio (T4/T1) were measured. The ED80 for T1 recovery depended on the dose of enflurane: 0.08 (SEM 0.03), 0.21 (0.06) and 0.42 (0.18) mg kg-1 for 0%, 1% and 2% enflurane, respectively (P less than 0.005). With enflurane 2% discontinued, the ED80 was 0.095 (0.050) mg kg-1 (P less than 0.02 compared with 2% enflurane).(ABSTRACT TRUNCATED AT 250 WORDS)