Articles: general-anesthesia.
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A patient with an intracardiac conduction defect characterised by first degree atrioventricular block due to slowed transmission through the atrioventricular node with increased refractoriness of the node, is described. Asymptomatic first degree block, rarely progressing to transient Wenckebach (type 1 second degree) block had been present for a period of 32 years until general anaesthesia was required, when profound bradycardia attributable to complete atrioventricular block developed abruptly. Subsequent investigations located delayed intracardiac conduction through the atrioventricular node, and indicated excess vagal activity rather than structural disease as the cause. The significance of first degree heart block is discussed in relation to other forms of atrioventricular conduction defect and the current recommendations for temporary pacing for elective general anaesthesia.
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We report a patient with Duchenne muscular dystrophy who developed malignant hyperpyrexia during general anaesthesia. During anaesthesia bradycardia was followed by ventricular fibrillation, on which ventricular flutter supervened and a body temperature rise of 0.6 degrees C for 15 minutes, myoglobinuria and elevation of CPK level were observed. ⋯ Diagnosis of Duchenne muscular dystrophy was first established after the development of malignant hyperpyrexia in the present case as well as in previously reported cases. Determination of serum CPK is very important before general anaesthesia.
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The neuromuscular effects of ORG NC45, used as the sole muscle relaxant, were compared with a succinylcholine-pancuronium sequence in patients during nitrous oxide-fentanyl anaesthesia. The subjects were divided into four groups with ten in each group. After induction of anaesthesia they received either succinylcholine, 1 mg . kg-1 or ORG NC45 in doses of 50, 70 or 90 micrograms . kg-1 and tracheal intubation was done 90 seconds later. ⋯ No cumulative effects were seen with either drug during the first hour of neuromuscular blockade. At the end of the operation the neuromuscular block was antagonized with atropine 18 micrograms . kg-1, and neostigmine 36 micrograms . kg-1 and recovery was significantly more rapid with NC45 than pancuronium. We conclude that the lack of cumulation, easy reversibility and lack of cardiovascular effects suggest that NC45 has advantages over currently available non-depolarizing muscle relaxants but that its onset of action is too slow for rapid intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Alfathesin and etomidate for minor outpatient anaesthesia.
Etomidate was compared with alfathesin for induction and maintenance of anaesthesia in a double-blind fashion in 48 fit patients undergoing minor gynaecological operations as outpatients. The patients were randomized to receive either etomidate 0.3 mg . kg-1 or alfathesin 75 microliters . kg-1 as intravenous induction agents. All patients received fentanyl 1 microgram . kg-1 and breathed 70 per cent nitrous oxide in oxygen. ⋯ Recovery was equally rapid in both groups. No adverse reactions were seen. Alfathesin would appear to be preferable to etomidate as an induction and maintenance agent in unpremedicated fit outpatients undergoing minor gynaecological operations.