Anesthesia and analgesia
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Anesthesia and analgesia · May 1976
Case ReportsProlonged neuromuscular blockade with pancuronium in the presence of acute renal failure: a case report.
Prolongation of neuromuscular block following pancuronium administration to anephric patients has been reported. A patient is described whose postoperative course after resection of gangrenous bowel was complicated by acute renal failure and prolonged neuromuscular blockade. A large intraoperative dose of pancuronium was administered without monitoring neuromuscular transmission with a peripheral nerve stimulator. ⋯ The absence of renal excretion considerably increases the duration of action of curare when given in high doses. It has been suggested that doses of pancuronium greater than 3.6 mg/sq m or multiple doses would result in prolonged neuromuscular block in patients without renal function. The case reported illustrates the importance of monitoring neuromuscular transmission during administration of pancuronium in the presence of renal insufficiency to avoid this complication.
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Ketamine given IV in a dose of 2 mg/kg caused a significant reduction in Pao2 in 7 patients spontaneously breathing with an unassisted airway. Under the same conditions, in 7 patients, ketamine (2 mg/kg IV) preceded by diazepam (0.2 mg/kg IV) also caused a reduction in Pao2 not significantly different from that caused by ketamine. In some patients, alarmingly low levels of Pao2 ( less than or equal to 40 torr) were seen following ketamine administration. Based on these findings, the authors recommend that O2 and ventilatory assistance accompany ketamine given IV for anesthesia.
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Anesthesia and analgesia · May 1976
Comparative StudyThe effect of enflurane, isoflurane, fluroxene, methoxyflurane and diethyl ether anesthesia on ouabain tolerance in the dog.
Digitalis tolerance in dogs anesthetized with enflurane, isoflurane, fluroxene, methoxyflurane, and diethyl ether was compared with that in dogs anesthetized with pentobarbital. Ouabain dosage needed to cause ventricular tachycardia was significantly higher than that of pentobarbital with all agents except fluroxene, as was the LD50. The relative potency of these anesthetics in converting ouabain-induced ventricular tachycardia to sinus rhythm, in order of descending effectiveness, was: diethyl ether, methoxyflurane, enflurane, fluroxene, isoflurane, pentobarbital.
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Anesthesia and analgesia · May 1976
Comparative Study Clinical Trial Controlled Clinical TrialAn evaluation of memory under regional anesthesia with IV lorazepam as a premedicant.
Forty male volunteer patients undergoing regional anesthesia were evaluated for alertness and memory in a double-blind study which compared IV lorazepam (4 mg) plus IM meperidine (50 mg) with IV placebo plus IM meperidine (50 mg) as premedicants. The data indicate no significant retrograde effects. ⋯ A significant number of patients over age 40 were judged to be excessively sedated after administration of lorazepam. However, respiration, blood pressure, and pulse did not appear to be differentially affected by lorazepam and there were no adverse changes even in patients considered to be oversedated.