British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Relationship of post-tetanic count and train-of-four response during intense neuromuscular blockade caused by atracurium.
Atracurium-induced intense neuromuscular blockade was evaluated in 60 randomly selected patients using the post-tetanic count (PTC) and train-of-four (TOF) methods. Thirty patients were anaesthetized with thiopentone, nitrous oxide and halothane, and 30 patients received thiopentone, nitrous oxide and fentanyl. In all patients, the response to post-tetanic single twitch stimulation appeared before the response to TOF stimulation, and a close correlation was found between the number of post-tetanic twitches (PTC) and the time interval between the PTC and the first detectable TOF response. ⋯ A PTC of 1 meant that the TOF response would appear in, on average, 9 min (95% confidence limits: 4-14 min). Halothane significantly prolonged the time from injection of atracurium to the first response to post-tetanic single twitch stimulation. It is concluded that the relationship between PTC and the time to first response to TOF nerve stimulation makes the PTC method a valuable supplement to TOF nerve stimulation for neuromuscular monitoring during clinical anaesthesia involving atracurium.
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Malignant hyperpyrexia developed, and was successfully treated, in a 50-year old man undergoing pyelolithotomy. Early diagnosis with the assistance of end-tidal carbon dioxide monitoring facilitated prompt treatment with i.v. dantrolene. A positive muscle biopsy subsequently confirmed the diagnosis. The only likely triggering agent used was isoflurane.
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Biography Historical Article
A British footnote to the life of Horace Wells.
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Randomized Controlled Trial Clinical Trial
Onset and recovery of atracurium and suxamethonium-induced neuromuscular blockade with simultaneous train-of-four and single twitch stimulation.
Single twitch and train-of-four stimulation were applied at 0.08 Hz to each ulnar nerve and the force of contraction of the adductor pollicis was recorded during onset of and recovery from neuromuscular blockade by suxamethonium 1 mg kg-1 or atracurium 0.4 mg kg-1. Times to 90% first twitch blockade of train-of-four were (mean +/- SEM) 0.82 +/- 0.08 and 1.98 +/- 0.18 min for suxamethonium and atracurium, respectively, compared with times to 90% single twitch blockade of 1.00 +/- 0.07 and 3.35 +/- 0.37 min, respectively (P less than 0.05 in both cases). ⋯ The mode of stimulation had little effect on time to 10% recovery. The results are consistent with stimulation-induced augmentation in muscle blood flow, which increased delivery of the drug to the neuromuscular junction.