British journal of anaesthesia
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Clinical Trial
Pulmonary function and head lift during spontaneous recovery from pipecuronium neuromuscular block.
We have studied in seven healthy conscious volunteers the correlation between the electromyographic (EMG) and clinical criteria used to identify adequate recovery from sub-paralysing doses of pipecuronium. Pipecuronium (mean dose 1.88 (range 0.92-3.16) mg) was administered to reach a T4/T1 ratio of 0.5; full recovery to 1.0 was produced in a mean time of 25.3 (14-39) min. During recovery from neuromuscular block, we measured tidal volume, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) negative inspiratory pressure (NIP), peak expiratory flow rate (PEFR), mid-expiratory flow rate (MEFR) and 5-s head lift. ⋯ There was a statistically significant decrease in FVC, FEV1 and PEFR with a nonsignificant decrease in other pulmonary measurements, except for NIP which only decreased significantly at a ratio of 0.5. These changes are probably of no clinical importance. All the measured respiratory variables returned to control values at a TOF ratio of 0.9.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness and sequelae of very low-dose suxamethonium for nasal intubation.
We have studied the effectiveness and sequelae of low-dose suxamethonium in 60 day-case oral surgery patients requiring nasal intubation. Anaesthesia was induced with propofol and alfentanil; 60 patients were allocated randomly to three groups of 20 patients and received no suxamethonium, suxamethonium 0.25 mg kg-1 or 0.5 mg kg-1. ⋯ Good intubating conditions were produced in all 20 patients receiving suxamethonium 0.25 mg kg-1, in 19 patients receiving suxamethonium 0.5 mg kg-1 and in 11 patients not receiving a neuromuscular blocker. The incidence of postoperative myalgia after suxamethonium 0.25 mg kg-1 (20%) did not differ significantly from the incidence after propofol and alfentanil alone (28%).
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Randomized Controlled Trial Clinical Trial
Dose-response studies of the interaction between mivacurium and suxamethonium.
We have determined the effect of pretreatment with mivacurium on the potency of suxamethonium and the effect of prior administration of suxamethonium on the potency of mivacurium. We studied 100 ASA I or II patients during thiopentone-fentanyl-nitrous oxide-isoflurane anaesthesia. Neuromuscular block was recorded as the evoked thenar mechanomyographic response to train-of-four stimulation of the ulnar nerve (2 Hz at 12-s intervals). ⋯ The calculated doses producing 50% depression of T1 (ED50) were 86 (95% confidence intervals 83-88) and 217 (208-225) micrograms kg-1 for suxamethonium alone and after mivacurium, respectively. This study also demonstrated that prior administration of suxamethonium did not appear to influence either the slope of the regression lines or the potency of mivacurium. Combining the results of this study with a previous study (mivacurium ED50 = 20.8 (20.3-21.3) micrograms kg-1 during isoflurane-nitrous oxide anaesthesia), we suggest that the potency of mivacurium did not differ from that observed after suxamethonium (17.4 (16.9-17.9) micrograms kg-1).
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To determine the accuracy of subject and author indexes in five anaesthesia journals we examined all 1989 and 1991 volumes of Anesthesia and Analgesia, Anesthesiology, British Journal of Anaesthesia, Canadian Journal of Anaesthesia and European Journal of Anaesthesiology, and counted the number of entries and the number of errors in both indexes. The number of errors was expressed as a percentage of the number of entries, and the incidences of errors were compared by chi-square contingency table tests. ⋯ British Journal of Anaesthesia had the lowest error rate (0.9%), followed by Anesthesia and Analgesia (2.4%), Anesthesiology (3%), European Journal of Anaesthesiology (2.9%) and Canadian Journal of Anaesthesia (11.4%). The combined index accuracy was improved from 1989 to 1991 for Anesthesia and Analgesia, British Journal of Anaesthesia and Canadian Journal of Anaesthesia, did not change for European Journal of Anaesthesiology and was worse for Anesthesiology.
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Comparative Study
Haemodynamic and catecholamine responses to induction of anaesthesia and tracheal intubation in diabetic and non-diabetic uraemic patients.
We have studied cardiovascular and catecholamine responses to induction of anaesthesia and tracheal intubation in 13 patients with diabetic nephropathy, in 12 patients with uraemia of other origin and in 12 ASA I control patients. All uraemic patients were undergoing renal transplantation. Cardiovascular autonomic function tests indicated that severe autonomic neuropathy was common in the diabetic patients; less severe impairment of autonomic function was found in the non-diabetic uraemic patients. ⋯ The increased plasma concentrations of catecholamines in the uraemic patients may be a result of impaired clearance of catecholamines and higher sympathoadrenal activity needed to maintain cardiac function. The normal systolic pressor response to tracheal intubation in the uraemic patients indicates that the capacity of the cardiovascular system to respond to a stressful stimulus was preserved in these patients also, in spite of autonomic neuropathy. The greater response in the diabetic group may be caused by increased sensitivity to catecholamines and loss of autonomic control.