European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · Nov 1995
ReviewIntravenous anaesthetic drug interactions: practical applications.
The spectrum of effects that constitutes the state of general anaesthesia can be induced by the combined use of drugs. Each drug has a predominant action regarding one of the anaesthesia components, hypnosis, analgesia and amnesia. However, each agent, when used in combination, not only produces its own expected effect, but it can also modify the effect of another agent acting on a different component. ⋯ Pharmacologists have provided us with techniques to measure drug interactions. We have utilized these techniques to demonstrate and quantify significant pharmacological interactions for hypnotic effect with commonly used intravenous agents. The clinical utility of these combinations can now be exploited precisely for the benefit of all our patients.
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Eur J Anaesthesiol Suppl · Nov 1995
Randomized Controlled Trial Comparative Study Clinical TrialPropofol versus propofol with midazolam for laryngeal mask insertion.
We evaluated the addition of midazolam to propofol during induction of anaesthesia by assessing laryngeal mask tolerance, haemodynamic variables, recovery times and cost. Forty patients (ASA grades I-IV) undergoing elective surgery were allocated randomly to receive a standard dose of propofol or a smaller dose of propofol combined with midazolam. A laryngeal mask was inserted and any episodes of coughing or hiccuping during its insertion or removal were recorded. ⋯ No significant differences were detected in any variables, except that patients given propofol needed more morphine in the recovery ward. The average cost of propofol alone was 3.47 pounds per anaesthetic, while the midazolam plus propofol cost was 2.03 pounds. Adding midazolam to propofol allowed a reduced dose of propofol to be used without adverse effects, while reducing the anaesthetic costs.
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We investigated the bacterial contamination of commonly used intravenous anaesthetic agents. Ten trainee anaesthetists drew up four syringes each of propofol, midazolam, thiopentone, 0.9% saline and a culture medium control using their normal practice. A set of syringes was cultured at the time of drawing up and at 2, 4 and 8 h afterwards. ⋯ We cannot recommend drawing up drugs at the start of a list for use later in the day. They should be used immediately after drawing up. Basic hand washing before drawing up drugs may reduce contamination.
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Eur J Anaesthesiol Suppl · Sep 1995
Comparative Study Clinical Trial Controlled Clinical TrialIntubation conditions and time-course of action of low-dose rocuronium bromide in day-case dental surgery.
A relatively small dose of rocuronium (0.45 mg kg-1) was compared with equipotent doses of atracurium (0.35 mg kg-1) and vecuronium (0.075 mg kg-1) for ease of intubation at 60 s. All patients could be intubated but the proportion with excellent or good conditions was much greater with rocuronium. Mean clinical duration of effect of this dose was 22.2 min. There was no correlation between intubating conditions and the degree of block of the adductor policis.
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Eur J Anaesthesiol Suppl · Sep 1995
Randomized Controlled Trial Comparative Study Clinical TrialPriming studies with rocuronium and vecuronium.
We studied the effects of rocuronium and vecuronium as priming agents before both vecuronium and rocuronium neuromuscular blockade. Rocuronium is ineffective at priming rocuronium. Vecuronium is effective at priming rocuronium, producing an approximate 33% reduction in onset time. Rocuronium and vecuronium, when given as priming agents, both reduce the onset time of vecuronium block.