Articles: general-anesthesia.
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Facial and hand muscles are used frequently for monitoring neuromuscular blockade. Therefore, we compared changes in electrically evoked muscle potential magnitude in upper facial and hypothenar muscles after fixed doses of neuromuscular blockers (succinylcholine, 750 micrograms/kg; pancuronium, 70 micrograms/kg; vecuronium, 50 micrograms/kg; and atracurium, 300 micrograms/kg). Face-hand comparisons were made in both anesthetized (nitrous oxide/narcotic, n = 51) and comatose (closed-head injuries, n = 5) patients. ⋯ The neuromuscular blockade in both the hand (49 +/- 54%) and the upper facial area (68 +/- 28%, P greater than 0.05) of comatose patients was smaller and more variable than that seen during anesthesia. These results illustrate the value of quantitative monitoring of neuromuscular function, especially during highly variable and unpredictable drug-induced blockade in the comatose state. We conclude that during narcotic-based anesthesia the upper facial and hand muscles are differentially sensitive to commonly used neuromuscular blockers.
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Randomized Controlled Trial Comparative Study Clinical Trial
Maternal inspired oxygen concentration and neonatal status for caesarean section under general anaesthesia. Comparison of effects of 33% or 50% oxygen in nitrous oxide.
The relationship between maternal FIO2 and umbilical venous PO2, PCO2, pH and neonatal Apgar and TSR (time to sustained respiration) scores was studied in 35 patients undergoing Caesarean section under general anaesthesia. Patients were allocated randomly to breathe an FIO2 of either 0.5 or 0.33. ⋯ No differences were found between groups for 1- or 5-min Apgar scores or TSR values. It is concluded that no difference in fetal outcome or acid-base status can be detected when maternal FIO2 is decreased from 0.5 to 0.33, and that the use of 33% oxygen in 66% nitrous oxide appears to be safe for neonates who have not suffered fetal distress before delivery.
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Comparative Study
Hemodynamic effects of doxacurium chloride in patients receiving oxygen sufentanil anesthesia for coronary artery bypass grafting or valve replacement.
Doxacurium chloride is an investigational long-acting neuromuscular blocking drug, which has been shown to be devoid of cardiovascular side effects when administered in modest doses to healthy patients. This is the first hemodynamic study of doxacurium in adult patients with cardiac disease. Forty-one patients scheduled to undergo cardiac surgery were studied. ⋯ At no time was there any significant change in mean arterial pressure, right atrial pressure, or cardiac output. Likewise derived hemodynamic variables including cardiac index, stroke volume, and pulmonary vascular resistance were unchanged. In addition to the decrease in heart rate, the hemodynamic changes, which reached statistical significance, were clinically insignificant and occurred predominantly in the group of patients receiving doxacurium 0.08 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)
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A mother with the Klippel-Feil syndrome, congenital hydrocephalus and increased intracranial pressure presented for delivery by Caesarean section at 33 weeks because of pre-eclampsia. Anaesthetic management comprised awake intubation using the fibreoptic bronchoscope, followed by induction and maintenance of general anaesthesia for the delivery of a live male infant. This case report describes the problems arising under these circumstances and the relative merits of different anaesthetic techniques.