British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of atracurium and alcuronium during halothane anaesthesia by measurement of the train-of-four response of the adductor pollicis muscle and clinical observation.
Atracurium and alcuronium have been compared during halothane anaesthesia, by measurement of the mechanical response of the adductor pollicis muscles to train-of-four stimulation and by clinical observation. Atracurium appeared significantly shorter-acting than alcuronium. However, results suggested that the action of alcuronium may not be of "medium duration". A comparison of three indices of muscle twitch response to the train-of-four nerve stimulation, seemed to indicate that the D'/D ratio gave the best overall index of neuromuscular blockade in this study.
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An inhibition assay was used to determine quantitatively the allergenic cross-reactivity of some myoneural blocking drugs not yet released for use in Australia, in the sera of patients who had experienced anaphylactic reactions to neuromuscular blocking drugs. Two of the compounds, metocurine and atracurium were highly cross-reactive with the currently used myoneural blockers; fazadinium was weakly cross-reactive and vecuronium intermediate in potency between these two extremes. From these results, we predict that anaphylactic reactions to these compounds, and particularly to metocurine and atracurium, will occur in some patients allergic to the currently used neuromuscular blocking agents.
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The presentation and features of Duchenne's progressive muscular dystrophy (Duchenne's PMD) are described and the increased risks associated with anaesthesia are considered. Hazards associated with induction of anaesthesia and immediate postoperative recovery have been stressed in recent case reports, and these are summarized. Features of a hyperpyrexia-like response including cardiac arrest, increased serum creatine phosphokinase concentration, myoglobinuria and metabolic acidosis following suxamethonium or halothane, or both, have been described in patients with Duchenne's PMD. ⋯ In five of the children, cardiac arrest occurred despite apparently adequate respiratory support. Suxamethonium was common to the anaesthetic received by all six patients. In one of these patients subsequent anaesthetics, without suxamethonium, were uneventful and delayed muscle weakness did not occur.
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The case of a pregnant patient with diffuse scleroderma who died following Caesarean section under general anaesthesia is presented. The patient's postoperative course was complicated by pulmonary oedema and pulmonary hypertension, sepsis, thrombocytopenia and renal failure. Aspects of the disease which possess anaesthetic implications are reviewed.
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Comparative Study
Effect of meptazinol on neuromuscular transmission in the isolated rat phrenic nerve-diaphragm preparation.
Meptazinol has been shown to have significant effects on neuromuscular transmission in the isolated rat phrenic nerve-diaphragm preparation. The response of the preparation to indirect electrical stimulation was increased in a concentration-dependent manner by meptazinol hydrochloride 2-32 micrograms ml-1. ⋯ These effects were similar to those obtained with neostigmine and it was demonstrated that meptazinol had significant anti-cholinesterase activity in the concentrations used. Inhibition of cholinesterase with ecothiopate revealed a neuromuscular blocking activity of meptazinol in concentrations as low as 0.25 micrograms ml-1.