European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · Jan 1994
The contribution of muscle relaxants to the advancement of anaesthetic practice: what is required of new compounds?
The introduction of each new muscle relaxant has advanced anaesthetic practice by trying to meet some perceived deficiency in the existing therapeutic armamentarium. Anaesthesiologists need agents which are appropriate to the duration of surgery: they prefer agents which are not subject to drug interaction, have no effect on cardiovascular function, which do not depend significantly on renal excretion, which are easy to reverse, and which have a rapid onset of action. In certain circumstances one of these requirements becomes overridingly important. The latest new addition, rocuronium, fills the gap for an agent with rapid onset while lacking the potentially adverse features of suxamethonium, retaining a medium duration of action and meeting the other requirements set out above as well as any existing agent.
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Eur J Anaesthesiol Suppl · Jan 1994
An overview of the pharmacology of rocuronium bromide in experimental animals.
In various animal species anaesthetized with a-chloralose (cats and pigs) or pentobarbitone (Beagle dogs and Rhesus monkeys), rocuronium has been shown to be a readily reversible, non-depolarizing neuromuscular blocking agent with a similar duration of action as vecuronium but a 6-10 fold lower potency. The outstanding features of its action is rapidity of onset. ⋯ There is no evidence of any selective pre-junctional effect and there is no clinically relevant inhibition of acetycholinesterase. Screening in rats has not demonstrated any oestrogenic, androgenic, anabolic, glucocorticoid-like or gonad-inhibiting properties, although there was a slight increase in pituitary weight in male rats.
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Eur J Anaesthesiol Suppl · Jan 1993
Randomized Controlled Trial Comparative Study Clinical TrialHaemodynamic effects and comparison of enoximone, dobutamine and dopamine following mitral valve surgery.
Mitral valve surgery may be complicated by a post-operative low output state requiring inotropic support, and a wide variety of factors may influence the choice of agents used to treat this condition. The authors have examined and compared the haemodynamic effects of the highly specific phosphodiesterase inhibitor enoximone, and the adrenergic agents dobutamine and dopamine in patients undergoing mitral valve surgery. Enoximone, 0.5 mg kg-1 bolus, followed by a continuous infusion of 5 micrograms kg-1 min-1, was compared against dobutamine, 7 micrograms kg-1 min-1, and dopamine, 5 micrograms kg-1 min-1, with the protocol allowing for an increase in the infusion rate by a factor of two if clinical and haemodynamic measurements indicated. ⋯ Three of the 25 patients receiving dobutamine were withdrawn from the study because of inadequate haemodynamic response, while the remaining 22 patients demonstrated significant increases in heart rate, cardiac index and stroke index, with a reduction in systemic vascular resistance. Nine of the 25 patients receiving dopamine failed to respond adequately, while the remaining 16 demonstrated an increase in heart rate and cardiac index but with little change in stroke index and a modest reduction in systemic vascular resistance. Enoximone has been shown to be a highly effective first-line inotrope in patients following mitral valve surgery with significant advantages over dobutamine and dopamine.
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Eur J Anaesthesiol Suppl · Jan 1993
ReviewRisk assessment in the formulation of anaesthesia safety standards.
Risk assessment involves identifying hazards and then estimating their chance of occurrence and their severity. Risk management involves the cost-effective reduction of risk to levels perceived to be acceptable to society; risk levels set by experts may not be accepted, as perceived risk is strongly influenced by the nature of the adverse outcome and the context in which it was incurred. An understanding of the psychology of risk perception may lessen the negative impact of disasters and may better prepare the victims and their relatives. ⋯ These constituted one to two thirds of all incidents during anaesthesia, and account for most causes of brain damage that are dealt with by medical insurance companies. The size of the settlements provides evidence that these are viewed as very serious problems. Minimum standards were formulated with this information in mind; in recommending a sequence for equipment purchases great emphasis was placed on preventing the patient from breathing hypoxic gas mixtures, and on continuous monitoring of the adequacy of the airway, ventilation, the circulation and tissue oxygenation.