British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Thenar muscle blood flow and neuromuscular effects of vecuronium in patients receiving balanced or isoflurane anaesthesia.
We have tested the hypothesis that isoflurane potentiates non-depolarizing neuromuscular block via an increase in muscle blood flow. Anaesthesia was induced with thiopentone 4-5 mg kg-1 in 30 adult male patients of ASA physical status I or II and was maintained with 70% nitrous oxide in oxygen supplemented with either a bolus dose of fentanyl 4 micrograms kg-1 followed by an infusion of 1 microgram kg-1 h-1 (balanced anaesthesia group, n = 15) or 1.1% end-tidal isoflurane (isoflurane group, n = 15). Vecuronium 0.1 mg kg-1 was given for neuromuscular block. ⋯ Thenar muscle blood flow was comparable in the two groups throughout the study. We conclude that isoflurane prolonged vecuronium-induced neuromuscular block. This prolongation was not related primarily to increase in muscle blood flow.
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We have compared the effects of two different frequencies of train-of-four stimulation of the ulnar nerve (2-Hz stimulation once every 10 or 20 s) on onset time and potency of atracurium, vecuronium and mivacurium during balanced anaesthesia. The adductor pollicis EMG was recorded simultaneously in both hands of 24 children aged 2-12 yr. After administration of an ED50 dose of each blocker, onset times were mean 21 (SEM 10) s shorter (P < 0.05) and decreases in neuromuscular function were 22 (3)% greater (P < 0.001) in the hand which was stimulated once every 10 s. We conclude that it is not possible to compare potency estimates of neuromuscular blocking agents if different stimulation patterns have been used.
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We report a case of tracheal rupture in an 84-yr-old patient after tracheal intubation. The aetiology and treatment are discussed and the recent literature is reviewed.
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Randomized Controlled Trial Comparative Study Clinical Trial Retracted Publication
Post-tetanic count and single twitch height at the onset of reflex movement after administration of vecuronium under different types of anaesthesia.
We have studied post-tetanic count (PTC) and single twitch height at the onset of reflex movement to carinal stimulation after administration of vecuronium with five different types of anaesthesia. Seventy-five adult patients were allocated randomly to five groups of 15 patients each, to receive one of the following anaesthetics: neuroleptanaesthesia (fentanyl and droperidol) or 1 MAC of either halothane, isoflurane, enflurane or sevoflurane with 66% nitrous oxide in oxygen. ⋯ Single twitch heights at the onset of reflex movement were similar (2.0-2.7% of control values) between the five groups. In contrast, PTC at the onset of reflex movement to carinal stimulation differed (7.4-17.0) between groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery.
In a prospective, double-blind, randomized study, we have compared i.v. ketorolac and morphine in paediatric outpatients undergoing strabismus surgery. Forty-two ASA I or II children, aged 2-12 yr, were allocated randomly to receive either ketorolac 0.75 mg kg-1 i.v. or morphine 0.1 mg kg-1 i.v. and metoclopramide 0.15 mg kg-1. Anaesthesia was induced with propofol and maintained with propofol and nitrous oxide. ⋯ There was no difference in pain behaviour scores or recovery times. The incidence of nausea and vomiting during the first 24 h was 19% in the ketorolac group and 71% in the morphine group (P < 0.001). We concluded that ketorolac was an effective analgesic for this type of surgery and that it was associated with less postoperative emesis than morphine and metoclopramide.