British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study Clinical Trial
Spontaneous or neostigmine-induced recovery after maintenance of neuromuscular block with Org 9487 (rapacuronium) or rocuronium following an initial dose of Org 9487.
We have examined spontaneous and neostigmine-induced recovery after an initial dose of Org 9487 1.5 mg kg-1 followed by three repeat doses of Org 9487, a 30-min infusion of Org 9487 or two incremental doses of rocuronium. Mean clinical duration after incremental doses of Org 9487 0.5 mg kg-1 increased from 12.3 (SD 3.4) min to 14.0 (4.0) and 15.9 (5.9) min (P < 0.01), and after rocuronium from 14.4 (5.2) min to 19.2 (5.9) min (P < 0.01). ⋯ These times were significantly reduced to 9.9 (4.5), 8.6 (6.1) and 5.7 (2.5) min, respectively, after neostigmine administration at a T1 of 25% (P < 0.05). We conclude that administration of Org 9487 by repeat bolus doses or infusion was associated with slow spontaneous recovery but neostigmine administration resulted in adequate recovery in less than 10 min.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of bispectral EEG analysis and auditory evoked potentials for monitoring depth of anaesthesia during propofol anaesthesia.
We have compared the auditory evoked potential index (AEPIndex) and bispectral index (BIS) for monitoring depth of anaesthesia in spontaneously breathing surgical patients. Twenty patients (aged 17-49 yr) undergoing day surgery were anaesthetized with computer-controlled infusions of propofol. The mean (SD and range) of each measurement was determined during consciousness and unconsciousness and at specific times during the perioperative period. ⋯ The average awake values of AEPIndex were significantly higher than all average values during unconsciousness but this was not the case for BIS. BIS increased gradually during emergence from anaesthesia and may therefore be able to predict recovery of consciousness at the end of anaesthesia. AEPIndex was more able to detect the transition from unconsciousness to consciousness.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of rocuronium compared with succinylcholine on intraocular pressure during rapid sequence induction of anaesthesia.
We have compared the effect of rocuronium and succinylcholine on intraocular pressure (IOP) during rapid sequence induction of anaesthesia using propofol and fentanyl, in a randomized double-blind study. We studied 30 adult patients, allocated to one of two groups. Anaesthesia was induced with fentanyl 2 micrograms kg-1 and propofol until loss of verbal response. ⋯ IOP in the succinylcholine group was significantly greater than that in the rocuronium group (mean 21.6 (SEM 1.4) mm Hg vs 13.3 (1.4) mm Hg; P < 0.001). Intubating conditions were equally good in both groups. We conclude that with rapid sequence induction of anaesthesia using propofol and fentanyl, rocuronium did not cause as great an increase in IOP as succinylcholine and may be an alternative in open eye injury cases.
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Randomized Controlled Trial Comparative Study Clinical Trial
Placement of the intubating laryngeal mask is easier than the laryngeal mask during manual in-line neck stabilization.
We have compared in 25 patients ease of placement of the conventional and intubating laryngeal masks while the patient's head and neck were stabilized by a manual in-line method, in a randomized, crossover study. After induction of anaesthesia and neuromuscular block, the masks were placed in turn. ⋯ Adequate ventilation was always obtained after placement of the intubating laryngeal mask, whereas ventilation was adequate in 22 of 25 patients after placement of the conventional laryngeal mask. Placement of the intubating laryngeal mask was significantly easier (P < 0.001; 95% confidence intervals (CI) for median difference 8-31 mm in VAS) and faster (P < 0.001; 95% CI for mean difference 3.2-6.2 s) than that of the conventional mask.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of a new piezoelectric train-of-four neuromuscular monitor, the ParaGraph, and the Relaxometer mechanomyograph.
The ParaGraph is a new device for monitoring neuromuscular function using a piezoelectric motion sensor. In 20 patients, monitoring of neuromuscular block produced by cisatracurium 0.1 mg kg-1 was compared using the ParaGraph and a Relaxometer 2 mechanomyograph. ⋯ There were no significant differences in the time to 100% depression of T1/T0, time to 25% recovery of T1/T0 or time to recovery of T1/T0 from 25% to 75%, measured by the two monitors. When the difference between the two monitors was plotted against the average of the two measurements, the limits of agreement for T1/T0 (-42.95, +53.98%) and the train-of-four ratio, T4/T1 (-0.28, +0.21) were too wide to allow the values given by the two monitors for individual patients to be used interchangeably.