AANA journal
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the onset time, duration of action, and fade characteristics of atracurium and vecuronium.
The speed of onset (T1 = 95% twitch depression) and the duration of action (T1 = 25% control) of equipotent doses of atracurium 0.5 mg/kg and vecuronium 0.1 mg/kg were compared in 21 ASA physical status I and II adult patients. Train-of-four (TOF) ratios (height of T4/T1) were also compared with the first response in the TOF recovered to 25% and 50% control, respectively. Neuromuscular function was measured by the Datex NMT 221 electromyograph at the hypothenar muscles. ⋯ Vecuronium was also found to exhibit significantly more TOF fade on offset of block than atracurium. Vecuronium may offer a distinct advantage over atracurium when a nondepolarizer is required for a relatively short clinical case. However, it appears that vecuronium causes more TOF fade during recovery from neuromuscular blockade than atracurium.
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The problems of intraoperative learning and awareness during surgery have consequences for both the patient and the medical team. With or without recall, the patient can suffer severe emotional trauma that may result in psychological damage. Successful litigation against the anesthesia professional has been increasing in numbers as failure to provide adequate anesthesia can be considered a breach of the unwritten contract between patient and anesthetist. ⋯ To date, means of monitoring real-time levels of intravenous agents have not yet been fully tested and proven. Therefore, monitoring minimum alveolar concentrations of inhaled anesthetics may be the best currently available method of ensuring anesthetic depth. Investigations comparing the correlation between nitrous oxide and isoflurane minimum alveolar concentrations and anesthetic depth have indicated specific levels at which intraoperative learning ceases to occur.