Pharm World Sci
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Clinically, neuromuscular blockade is induced with either depolarizing or non-depolarizing relaxants. Suxamethonium is the only depolarizing relaxant still in use. It is hydrolysed in the plasma by pseudo-cholinesterase (plasma cholinesterase). ⋯ Also, acid base balance disturbances, change in temperature, and neurological diseases have an effect on the profile of the relaxants. A number of drugs (anaesthetics, antibiotics, antiepileptics, etc.) have an effect on neuromuscular transmission, and thus interact with the relaxants. Some non-depolarizing relaxants cause histamine release and cardiovascular effects.
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Comparative Study Clinical Trial
Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU.
Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD. ⋯ The cessation of the routine application of SDD in post-operative patients mechanically ventilated for 5 days or more did nod adversely affect survival nor increased length of stay at the ICU. There may have been a shift to infections as a cause of death after cessation of SDD.
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Randomized Controlled Trial Clinical Trial
Epidural fentanyl and sufentanil for intra- and postoperative analgesia. A randomized, double-blind comparison.
In a double-blind, randomized study the efficacies of concentrated fentanyl and sufentanil injections as intraoperative epidural analgesics were compared. Also, the equivalent dose of fentanyl and sufentanil administered by continuous infusion during the first 24 h postoperatively, expressed in analgesia and also considering the side-effects was determined. 53 Patients undergoing elective thoracotomy, aortic surgery and bowel surgery were randomized and treated double-blind with fentanyl 0.250 mg/ml or sufentanil 0.05 mg/ml. Preoperatively, 0.5-1 ml study medication was administered, followed by increments of 0.2-0.5 ml during surgery guided by heart rate and systolic blood pressure. ⋯ There were no differences in required volume of study medication, heart rate and systolic blood pressure nor in the parameters assessed postoperatively. Administered doses were 27.5 micrograms/h fentanyl and 5.5 micrograms/h sufentanil. It was concluded that 0.250 mg/ml (0.74 mumol/ml) fentanyl is clinically equivalent to 0.050 mg/ml (0.13 mumol/ml) sufentanil.
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The stability of sufentanil (5 micrograms/ml as citrate) in admixtures with glucose 5% or bupivacaine hydrochloride (2 mg/ml) in 100 ml polyvinyl chloride portable pump reservoirs was investigated during simulated infusion by an epidural catheter at 32 degrees C for 48 h and during storage at 4 degrees C and 32 degrees C for 30 days. During both experiments a small decrease (< 5%) in concentration of sufentanil and bupivacaine was observed. ⋯ A significant decrease of sufentanil was observed when stored at 32 degrees C after 30 days when diluted with glucose (9.2%) or in combination with bupivacaine (8.9%); also, the bupivacaine concentration decreased significantly (4.1%). It is concluded that sufentanil in portable pump reservoirs can be used under patient conditions at 32 degrees C for 7 days when diluted with glucose 5% or 3 days in combination with bupivacaine hydrochloride.