Acta anaesthesiologica Belgica
-
Acta Anaesthesiol Belg · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialDouble-blind comparison between inverse sequence induction with atracurium and rapid sequence induction with succinylcholine.
In this double-blind randomized study of 60 patients, a new rapid sequence induction technique (RSI), the so-called inverse sequence induction technique (ISI), is compared to the standard RSI using succinylcholine (SUX). All patients were premedicated with midazolam 0.07 mg.kg-1 and morphine 5 mg im. The patients in the ISI group received atracurium 0.6 mg.kg-1 followed after 1 min by thiopental 5 mg.kg-1. ⋯ In both groups all patients were able to cough forcefully at the time of thiopental injection. These data emphasize the reliability and safety of ISI as an alternative for RSI when succinylcholine is contraindicated. However, the unpleasantness of awake partial curarization may limit its acceptance.
-
Acta Anaesthesiol Belg · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialEdrophonium is better than neostigmine to antagonize residual vecuronium induced neuromuscular block.
Edrophonium (EDR) has the advantages of a quick onset of action and reduced cholinergic effects compared to neostigmine (NST) when they are used to antagonize neuromuscular block (NMB). There are few studies about antagonism of very weak residual NMB. Therefore we compared hemodynamic stability, train-of-four (TOF) characteristics and reversal time (time from administration of antagonists to train-of-four-ratio (TR) at least 0.70) of EDR 0.5 mg kg-1 + atropine (ATR) 0.007 mg kg-1 to NST 0.04 mg kg-1 + glycopyrrolate (GLY) 0.008 mg kg-1 when they were used to antagonize a residual vecuronium (VEC)-induced NMB (T1 25-75%). ⋯ Heart rate was significantly higher in NST+GLY group 2 min after administration of the antagonists in comparison with the EDR+ATR group. The advantages of EDR (higher T1, TR and percentage of patients with an adequate recovery) were obvious during the first 5 min of reversal time. Therefore we conclude, that under the conditions described in the present study, EDR antagonizes residual VEC induced NMB faster than NST.
-
Acta Anaesthesiol Belg · Jan 1994
Randomized Controlled Trial Clinical TrialOnset and duration of action and hemodynamic effects of rocuronium bromide under balanced and volatile anesthesia.
The onset and duration of action, and hemodynamic effects of rocuronium bromide 0.6 or 0.9 mg kg-1 were studied in 4 groups of 10 patients each during anesthesia with nitrous oxide in oxygen and fentanyl or halothane. Neuromuscular block was monitored using mechanomyography and train-of-four (TOF) stimulation. The mean time to onset of complete neuromuscular block was 55 s with the 0.6 mg kg-1 dose during both anesthetic techniques. ⋯ There were no significant changes in heart rate or mean arterial pressure during the 5 min following administration of either dose of rocuronium during balanced or halothane anesthesia. A separate group of 10 patients received 0.9 mg kg-1 of rocuronium during anesthesia with nitrous oxide, oxygen and isoflurane. Complete block occurred in an average time of 45 s in these patients with 25% recovery of T1 in 53 min.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Acta Anaesthesiol Belg · Jan 1994
Randomized Controlled Trial Clinical TrialCirculatory drugs modify the hemodynamic actions of alfentanil combined with vecuronium or pancuronium.
To verify, whether drugs used to treat hypertension, coronary disease, and heart insufficiency modify the hemodynamic effects of the combinations alfentanil-vecuronium and alfentanil-pancuronium, 36 patients taking these drugs (most often beta-adrenergic antagonists) were randomized to receive either vecuronium or pancuronium in connection with ophthalmic surgery. In comparison with healthy patients, the heart rate and arterial pressure changes during induction, intubation and surgery appeared to be smoothed. ⋯ One third of the patients receiving vecuronium exhibited nodal rhythm and some of them showed slow heart rates during intense surgical stimulation. Pancuronium offered protection against bradyarrhythmias.
-
Acta Anaesthesiol Belg · Jan 1994
MRI and clinical study of an easy and safe technique of suprascapular nerve blockade.
Suprascapular nerve block is used with increasing frequency by anaesthetists and rheumatologists in the management of shoulder pain from a variety of disorders. In the classical technique, the needle is introduced into the supraspinous fossa perpendicular to the blade of the scapula and then is moved to enter the scapular notch, with the risk of pneumothorax or damage to the suprascapular nerve or vessels. ⋯ Introducing the needle parallel to the blade, i.e. away from the direction of the lung and the suprascapular nerve and vessels, and injecting the solution into the floor of the supraspinous fossa is an easy and safe technique. We report the results of a MRI and clinical study that confirm the efficacy of this approach.