British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia with hyperbaric bupivacaine: effects of concentration and volume administered.
A double-blind study was carried out using hyperbaric solutions of bupivacaine to compare the effects of varying the concentration of bupivacaine and the volume of solution administered intrathecally. Fifty-seven patients were studied. Ten patients received each volume of each concentration: 0.5% bupivacaine in 8% dextrose, 2 ml, 3 ml or 4 ml and 0.75% bupivacaine in 8% dextrose, 1.3 ml or 2 ml. ⋯ The use of 3 ml of this solution was abandoned after seven patients had received it because of the excessive spread. With both solutions, increasing the volume produced a longer duration of action. The use of a 0.75% solution of hyperbaric bupivacaine for spinal anaesthesia did not appear to confer any advantage over the 0.5% solution.
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Clinical Trial Controlled Clinical Trial
Effect of hypocarbia and hypercarbia on the antagonism of pancuronium-induced neuromuscular blockade with neostigmine in man.
The effects of variations in carbon dioxide concentration on the antagonism of pancuronium-induced neuromuscular block by neostigmine were studied in 21 patients: normocarbia (PE'CO2 5.4%, PaCO2 4.93 kPa, n = 7), hypocarbia (PE'CO2 3.6%, PaCO2 3.30 kPa, n = 7) and hypercarbia (PE'CO2 7.5%, PaCO2 7.13 kPa, n = 7). Mechanical and electromyographic responses to ulnar nerve stimulation (0.1 Hz and 2 Hz) were recorded. A 90% block during nitrous oxide in oxygen anaesthesia was maintained by incremental single injections of pancuronium and reversed with neostigmine 0.35 mg kg-1 with atropine 0.0175 mg kg-1. ⋯ A residual block of about 10% was seen in hypercarbic patients. However, the recovery of e.m.g. amplitude and train-of-four ratios was similar in all groups. Thus, the impaired recovery of twitch tension seems to be the result of depressed contractility rather than failure of neuromuscular transmission.
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Neuromuscular blocking agents are widely used in anaesthesia, and a simple quantitative method of monitoring their effects is desirable. This paper describes a new instrument which has been developed for electromyographic monitoring of neuromuscular block by a non-invasive technique which is both reliable and easy to use. The median nerve is stimulated at the wrist and the electromyogram (e.m.g.) from a thenar muscle is detected, rectified and integrated electronically to produce a meter display of the assessment of block. The method is recommended for routine use.
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A closed-circle absorber system incorporating an in-circle Goldman vaporizer was used to administer halothane or enflurane in oxygen to adult patients. The attained inspired and end-tidal concentrations of volatile agent after a period of stabilization at each vaporizer setting were measured by mass spectrometry. ⋯ Minimal pre-oxygenation was used to assess the problem of nitrogen accumulation within the circuit. The maximum nitrogen concentration was 56%.
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Randomized Controlled Trial Clinical Trial
Use of di-isopropyl phenol as main agent for short procedures.
The use of di-isopropyl phenol (Diprivan) for induction of anaesthesia was assessed in doses ranging from 1 to 3 mg kg-1. With less than 1.75mg kg-1 not all patients were anaesthetized; 2.0 mg kg-1 appeared to be a satisfactory induction dose. Involuntary muscle movement, cough and hiccup at induction were rare with any dose studied. ⋯ Recovery was rapid, and characterized by lack of emetic sequelae. Di-isopropyl phenol 1.5 - 2.0 mg kg-1 given rapidly during reactive hyperaemia can produce anaesthesia in one arm-brain circulation time. A reaction involving flush, hypotension, cough, laryngospasm and bronchospasm occurred in one patient receiving 2.5 mg kg-1 given over 20 s.