Articles: nerve-block.
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The purpose of this study was to compare the pattern of recovery from vecuronium 0.07 mg.kg-1 induced neuromuscular blockade using post-tetanic burst count (PTBC)-(three short tetanic bursts of 0.2 msec duration every 20 msec given every second following a tetanus), and post-tetanic count (PTC)-(0.2 msec single twitch stimuli given every second following a tetanus) using an accelerometer in 60 adult patients during nitrous oxide-oxygen-isoflurane anaesthesia. In addition, the relationship among PTBC, PTC, and T1 (the 1st response in the train-of-four (TOF) stimulation) was examined to investigate whether the PTBC had an advantage over the PTC or TOF for evaluating intense neuromuscular blockade. The PTBC was greater than PTC during the 15-35 min after the administration of vecuronium (unpaired t test with Bonferroni's correction, P < 0.05). ⋯ Time from the return of PTB to that of T1 was longer than the time from the return of PTC to that of T1 (13.3 +/- 2.6 vs 9.2 +/- 2.8 min, unpaired t test, P = 0.0003). At the return of T1, PTBC was greater than PTC (14.3 +/- 6.9 vs 9.4 +/- 2.3, unpaired t test, P = 0.0153). These results suggest that, using PTBC, a more profound level of neuromuscular blockade can be evaluated than that using PTC.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized double-blind controlled trial comparing room-temperature and heated lidocaine for digital nerve block.
To determine whether warming of lidocaine decreases the pain of its injection during digital nerve block. ⋯ Heating of lidocaine decreases the pain of injection during digital nerve block.
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Journal of anesthesia · Dec 1995
Difference of train-of-four fade induced by nondepolarizing neuromuscular blocking drugs: a theoretical consideration on the underlying mechanisms.
Nondepolarizing neuromuscular blocking drugs induce train-of-four (TOF) fade, i.e., the reduction of the fourth to the first twitch height in a train under TOF stimulation. It has been observed that the degree of TOF fade varies with the drug used and is inversely correlated with the potencies of the drug. ⋯ The model was based on the following assumptions: (1) Twitch response is evoked by the binding of acetylcholine (ACh) molecules to the postsynaptic nicotinic receptors in a neuromuscular junction, (2) time-dependent ACh mobilization in a motor nerve terminal results in less ACh output at the fourth stimulus in a train than at the first stimulus, (3) the drugs compete with ACh for the postsynaptic receptors and inhibit the receptor-binding of ACh, and (4) the drugs have various affinities for the receptors. This study suggested that the difference of affinities of the drugs for postsynaptic ACh receptors may cause the difference of TOF fade.
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Journal of anesthesia · Dec 1995
Effects of stellate ganglion block on cardiac coronary circulation.
Since the stellate ganglion contains cardiac sympathetic nerves, stellate ganglion block (SGB) may influence cardiac and coronary hemodynamics. We investigated this influence of SGB by measuring the heart rate (HR), the left circumflex coronary artery blood flow (CBF), the maximum rate of increase of the left ventricular pressure (LV max dP/dt), the cardiac output (CO), the myocardial oxygen consumption (MVO2), and the myocardial oxygen extraction ratio (MOER) in nine dogs before and after performing SGB by means of injection of 2 ml 1% mepivacaine. Left SGB resulted in a decrease of 10% in CBF and a decrease of 15% in LV max dP/dt, but HR, CO, and MVO2 remained unchanged. ⋯ Inhalation of 100% oxygen decreased MOER to the pre-SGB level in either side, thus improving the myocardial oxygen supply-demand relationship. This study suggests the possibility that SGB has deteriorative effects on the myocardial oxygen supply-demand relationship. Those effects were counteracted by the inhalation of 100% oxygen.