Acta anaesthesiologica Scandinavica. Supplementum
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Acta Anaesthesiol Scand Suppl · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparison of the neuromuscular effects of mivacurium and suxamethonium in infants and children.
We compared both the time course of neuromuscular blockade and the cardiovascular side-effects of suxamethonium and mivacurium during halothane and nitrous oxide anaesthesia in infants 2-12 months and children 1-12 years of age. Equipotent doses of mivacurium and suxamethonium were studied; 2.2 x ED95 was used in four groups of infants and children, while 3.4 x ED95 was used in two groups of children. Onset of neuromuscular block in infants was not significantly faster with suxamethonium than with mivacurium (P = 0.2). ⋯ Recovery of neuromuscular transmission to 25% of initial twitch height (T25) in infants and children was significantly faster after suxamethonium than after mivacurium, at 2.5 and 6 min, respectively (P < or = 0.05). In children given 3.4 x ED95 of suxamethonium or mivacurium, recovery from neuromuscular block was almost identical with the dose of 2.2 x ED95, with spontaneous recovery to T25 prolonged by only 0.5 min. No infant or child had hypotension after the mivacurium bolus dose.
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Acta Anaesthesiol Scand Suppl · Jan 1995
ReviewEffects of catecholamines on regional perfusion and oxygenation in critically ill patients.
Multiple organ failure is the major cause of death in patients with sepsis. Bacterial translocation from the gut is considered to induce and maintain sepsis. Therefore, the splanchnic region plays an important role in the pathogenesis and treatment of sepsis. ⋯ Catecholamines with beta mimetic effects are often used to increase DO2. The question as to whether dobutamine or dopamine should be used first in treatment of septic shock cannot be answered yet. Whether treatment with low dose dopamine or dopexamine actually improves renal function and splanchnic oxygenation is the purpose of ongoing studies.
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Acta Anaesthesiol Scand Suppl · Jan 1995
Randomized Controlled Trial Clinical TrialIntubating conditions and neuromuscular effects of mivacurium during propofol-alfentanil anaesthesia.
In three groups of 20 patients, anaesthetized with propofol and alfentanil, tracheal intubation conditions and the onset of neuromuscular blockade after administration of three different doses of mivacurium chloride (0.11, 0.15, and 0.19 mg/kg = 1.5 x ED95, 2 x ED95, and 2.5 x ED95) were assessed. Intubation conditions were found to be clinically acceptable (good or excellent) in 83% of patients. ⋯ We conclude that mivacurium chloride allows smooth intubation in most patients within 60-90 s, even with the lowest dose (0.11 mg/kg), after a propofol-alfentanil induction of anaesthesia. However, because there were a few patients in whom intubating conditions were inadequate at 60-90 s, we are reluctant to advocate the preference of mivacurium chloride over suxamethonium for rapid sequence induction in emergency situations.
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Acta Anaesthesiol Scand Suppl · Jan 1995
ReviewSpontaneous recovery or evoked reversal of neuromuscular block.
Recovery from the effects of muscle relaxants can occur either spontaneously by their metabolism in the body or by elimination via the normal excretion pathways, or by the administration of pharmacologic antagonists. The decision as to whether spontaneous recovery should be allowed to take place or pharmacologic reversal should be induced depends upon several factors, principal among them being the duration of action of the muscle relaxant used, its dose, and the time that is available. The recovery times of most relaxants, including atracurium and vecuronium, are such as to require antagonism if adequate recovery is to be attained quickly. An agent such as mivacurium may, however, allow complete spontaneous recovery to take place without the use of antagonists.
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Cellular tissue damage due to inadequate oxygen supply is frequently encountered in the critically ill patient and can be the end result of a number of conditions. The eventual disruption to the normal processes required for the cell to survive can be due either to the hypoxic state per se or by damage caused during reperfusion of the tissue. Blood gas analysis is commonly used as a macro indicator of oxygen supply, state of art blood gas analysers provide information for oxygen tension (pO2), haemoglobin oxygen saturation (SO2) and concentration (THb), ideally, in arterial and mixed venous blood. ⋯ The relatively rapid and accurate analysis of metabolites that accumulate in hypoxic states has allowed us to measure concentrations of blood lactate, pyruvate, beta-hydroxybutyrate and acetoacetate and calculate the lactate/pyruvate ratio and beta-hydroxybutyrate/acetoacetate ratio. These measurements and ratios can then be compared with the non invasive macro blood gas indicators in order to determine their effectiveness as additional "routine" investigations and to indicate how each of the variables contributes to the eventual diagnosis. The parameters used in this study are as follows: Oxygen tension-pO2, Haemoglobin oxygen saturation-SaO2, Haemoglobin concentration-THb, Hydrogen ion concentration as-pH, Concentration of extractable oxygen-Cx, Oxygen extraction tension-px, Conditional extraction at an assumed pvO2 = 30 mmHg-C(a-30)O2, Lactate and pyruvate, beta-hydroxybutyrate and acetoacetate.