British journal of anaesthesia
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Comparative Study
Comparison of the cardiovascular actions of ORG NC 45 with those produced by other non-depolarizing neuromuscular blocking agents in experimental animals.
The cardiovascular actions of 1- [(2 beta,3 alpha, 16 beta,17 beta)-3,17-bis(acetyloxy)-2-(1-piperidinyl)-androstan-16-yl]-1-methyl-piperidinium bromide (Org NC 45) are reviewed and compared with those of other non-depolarizing neuromuscular blocking drugs. Results obtained in anaesthetized cats and dogs have demonstrated that, in contrast to other neuromuscular blocking drugs, Org NC 45, even in doses 20 times greater than those required for neuromuscular block, has no effects on heart rate, arterial pressure, autonomic ganglia, adrenoceptors or baroreceptors activity. Studies in pithed rats and on guineapig atria have further shown that Org NC 45 has little effect on cardiac muscarinic receptors or on noradrenaline re-uptake mechanisms. These results suggest that Org NC 45 possesses significant advantages over presently used non-depolarizing neuromuscular blocking drugs, since its clinical use should not be associated with cardiovascular side-effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of premedication on etomidate anaesthesia.
The effect of premedication upon the induction of anaesthesia with etomidate was studied in 74 adult patients undergoing elective orthopaedic surgery. Premedication with fentanyl plus atropine or with diazepam plus atropine decreased the frequency of involuntary muscle movements without modifying the pattern of the circulatory effects of etomidate, although fentanyl increased the frequency of apnoea. Pain at the site of injection was not modified by premedication.
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A simple valve device is described for a co-axial tubing anaesthetic system which enables selection of the circuit characteristics of either a modified Mapleson A system for spontaneous breathing or a modified Mapleson D system for controlled ventilation. Thus, the system allows an economical fresh gas flow to be used during either controlled or spontaneous ventilation. The mode of ventilation may be changed during anaesthesia without adjusting the patient tubing or the attachment of the system to the anaesthetic machine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of etomidate in combination with fentanyl or diazepam, with thiopentone as an induction agent for general anaesthesia.
In 104 premedicated patients undergoing general surgery, anaesthesia was induced either with etomidate 0.3 mg kg-1 preceded by fentanyl 1.25 or 2.5 microgram kg-1 i.v.or diazepam 0.0625 or 0.125 mg kg-1 i.v., or with thiopentone preceded by fentanyl 1.25 microgram kg-1 i.v. Despite the use of fentanyl or diazepam, the frequency of pain on injection in patients receiving etomidate was between 32% and 53%, being rated as severe in 5-20% of patients. ⋯ The frequency of both pain and involuntary muscle movements was least when fentanyl 2.5 microgram kg-1 preceded the administration of etomidate. There was no significant relationship between the pain and muscle movement; three of 10 patients given etomidate into a central vein had such movements.