Canadian Anaesthetists' Society journal
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The hypothesis that administration of neostigmine in divided doses might accelerate the antagonism of neuromuscular blockade was investigated. Neostigmine 0.05 mg X kg-1 was administered either in a single bolus dose (Group I, n = 16) or in an initial dose of 0.01 mg X kg-1 followed three minutes later by 0.04 mg X kg-1 (Group II, n = 16) for antagonism of atracurium-induced blockade. ⋯ The rate of TOF ratio recovery was 2.5 times faster after neostigmine administration in divided doses. It is concluded that administration of neostigmine in divided doses, as described in this study, produced a significantly faster reversal of residual atracurium-induced neuromuscular blockade as compared to a single bolus administration.
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Case Reports
Cardiac arrest following inhalation induction of anaesthesia in a child with Duchenne's muscular dystrophy.
Cardiac arrest occurred in a 5 1/2-year-old child with suspected Duchenne's muscular dystrophy ten minutes following induction of anaesthesia with halothane, nitrous oxide and oxygen. No muscle relaxants were administered. The cardiac arrest was associated with hyperkalaemia, acidosis, myoglobinuria, elevated serum creatine phosphokinase and a 1.6 degrees C rise in temperature. The child made a complete recovery after receiving 90 minutes of cardiopulmonary resuscitation.
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Transcutaneous oxygen tension (PtcO2) was measured in 30 patients scheduled for elective pulmonary resection requiring one-lung ventilation during anaesthesia. Simultaneous PtcO2 and arterial oxygen tension (PaO2) measurements were taken preoperatively (preop), intraoperatively during two-lung endotracheal (ET) and one-lung endobronchial ventilation (EB), and postoperatively (postop). There was a significant correlation (r) between PtcO2 and PaO2 at all time periods: 0.97 (preop); 0.91 (ET); 0.83 (EB); 0.81 (postop). ⋯ In three, this was associated with arterial hypoxaemia and in one, haemodynamic compromise. In all four cases the PtcO2 was the first monitored parameter to change. As there is a substantial risk of developing hypoxaemia during thoracic anaesthesia, PtcO2 monitoring provides valuable early warning of impending hypoxaemia or haemodynamic compromise, thereby facilitating early therapeutic intervention.
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Clinical Trial Controlled Clinical Trial
The effects of cimetidine and ranitidine with and without metoclopramide on gastric volume and pH in morbidly obese patients.
The efficacy of preanaesthetic intravenous cimetidine versus ranitidine with and without metoclopramide for acid aspiration prophylaxis was assessed in 60 morbidly obese patients in a double-blind manner. Group 1 patients received cimetidine 300 mg + saline. Group 2 patients received cimetidine 300 mg + metoclopramide 10 mg. ⋯ Gastric fluid was aspirated for analysis of volume and pH following induction of anaesthesia. All four premedication regimens were equally effective in reducing the gastric volume and acidity and the inclusion of metoclopramide had no additive effect. Although statistically not significant, two patients in the cimetidine groups remained at risk (volume greater than 25 ml and pH less than 2.5) while no patients in the ranitidine groups remained so.
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Patients who present for abdominal aortic surgery often have significant atherosclerotic disease which may involve the coronary arteries. Haemodynamic responses occurring during fentanyl (100 micrograms X kg-1) oxygen anaesthesia for abdominal aortic surgery were studied in 16 patients. Anaesthesia was induced with fentanyl 100 micrograms X kg-1 with no supplemental doses and metocurine-pancuronium mixture (4:1). ⋯ Eleven of the 16 patients required treatment for postoperative hypertension. Five of the 16 patients developed myocardial ischaemia, defined as ST segment depression greater than 0.1 mV, at some time during the operative procedure. Unsupplemented fentanyl anaesthesia (100 micrograms X kg-1) was unable to maintain a hypodynamic circulation in patients having abdominal aortic operations.