Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · May 1990
Comparative Study Clinical Trial Controlled Clinical Trial[Evaluation of the degree of muscle blockade: a comparative study using electromyography of the muscular relaxation induced by pancuronium, atracurium and vecuronium].
To compare the muscle relaxing effect of pancuronium, atracurium and vecuronium, 99 patients operated on under neuroleptanesthesia were divided in three groups depending on whether they had received, during induction, pancuronium 0.1 mg/kg, atracurium 0.5 mg/kg, or vecuronium 0.1 mg/kg. One-fourth of the initial dose was repeated if necessary. The electromyographic study of the muscle relaxing effect was carried out with stimulation of the cubital nerve with courses of supramaximal square wave electric stimuli in 'trains of four'. ⋯ TDT was 126.2 +/- 19.9 min for pancuronium, 61.2 +/- 11.5 min for atracurium and 55.5 +/- 16.7 for vecuronium. The mean duration of the repeated dose was 52.7 +/- 8.4 min for pancuronium, 19.9 +/- 5 min for vecuronium and 10.9 +/- 5 min for atracurium. RI, which was similar for atracurium and vecuronium (12.7 +/- 1.7 min and 12.8 +/- 3.3 min), was longer for pancuronium (27.7 +/- 4.3 min).
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Rev Esp Anestesiol Reanim · Mar 1990
[Continuous infusion of epidural morphine to relieve postoperative pain. Protocol and results].
We have evaluated the efficaciousness and side effects of continuous administration of morphine by lumbar epidural route for relieving postoperative pain in major surgery of the abdomen and orthopedic surgery. Lumbar epidural catheters were placed to 25 patients (mean age, 52 years) before induction of general anesthesia. All patients received a 4 mg bolus dose of morphine sulfate 1 hour before finalization of general anesthesia and subsequently they were placed on a continuous infusion of morphine sulfate at 0.3-1 mg/h. ⋯ Duration of continuous analgesia varied from 3 to 5 days. No patient presented respiratory depression; four presented nausea and eight had urinary retention. We believe that continuous epidural infusion of morphine is efficacious and safe for the treatment of acute postoperative pain in patients undergoing abdomen major surgery and orthopedic surgery.
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The safety of regional anesthesia lies on a set of factors, namely, selection of the adequate technique, skill and proper training from the part of anesthesiologists and use of right equipment. The needle, as a prolongation of the hand of the anesthesiologist, must provide references in technique either by itself or joined to an objective method of nerve localization; this will result in a high percentage of success without iatrogenesis. ⋯ Results were analyzed by Fisher's exact test and were statistically significant in the three groups, a fact that would indicate some specificity of the characteristics of the needle in each group of techniques. It would seem reasonable to adopt those techniques appearing to be the most efficacious after analysis in order to increase percentage of success and achieve the greatest safety in the clinical practice of anesthesiologists.
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Rev Esp Anestesiol Reanim · Mar 1990
Comparative Study[Use of vecuronium and atracurium in continuous infusion. A comparative study using electromyography and accelerometry].
Vecuronium and atracurium, muscle relaxant agents of intermediate action, were administered in continuous infusion to 175 patients undergoing prolonged surgical operations with the purpose of achieving serum concentrations inducing maintained blocking of neuromuscular function. We used a 0.08 mg/kg or 0.5 mg/kg bolus intubation dose followed by a continuous infusion of vecuronium (72 patients) or atracurium (103 patients) 10 minutes after, at the necessary pace to maintain inhibition of neuromuscular transmission over 90%. Monitoring of relaxation was done by means of four supramaximal stimuli trains which were repeated every 20 seconds and applied to the cubital nerve. ⋯ Initial dose allowed an easy tracheal intubation and the constant relaxation achieved with 0.068 mg/kg/h and 0.46 mg/kg/h infusion of vecuronium and atracurium was adequate for all operations. Spontaneous recovery is often adequate at the end of operations in carefully monitored patients. Both monitoring methods are useful for clinical evaluation of neuromuscular transmission.
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Rev Esp Anestesiol Reanim · Mar 1990
[Usefulness of isoflurane in anesthesia in elective cesarean section].
A series of 25 patients undergoing iterative cesarean section under general anesthesia received isoflurane at 0.75% together with a mixture of O2 and N2O at 50% for anesthetic maintenance. The inhalant agent was withdrawn when closing fascia. ⋯ Mean hematocrit value was 31.43 (SD 1.27) at 6 hours of operation. Fetal arterial gasometric values and Apgar score at 5 and 10 minutes fell within acceptable limits.