Anesthesia and analgesia
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Anesthesia and analgesia · Aug 1981
Comparative StudyReversal of neuromuscular blockade: dose determination studies with atropine and glycopyrrolate given before or in a mixture with neostigmine.
Glycopyrrolate and atropine were studied in doses of 5, 10, or 15 microgram/kg and 10, 20, or 30 microgram/kg, respectively, given intravenously either before or in a mixture with neostigmine, 50 microgram/kg, at the time of reversal of neuromuscular block. When given first, both anticholinergic drugs produced a dose-related increase in heart rate; following the administration of neostigmine the heart rates decreased. When administered in a mixture with neostigmine, the 20- and 30-microgram/kg doses, but not the 10-microgram/kg dose of atropine were associated with an initial increase in heart rate. ⋯ The frequency of dysrhythmias was otherwise similar. It is recommended that anticholinergic drugs be administered in a mixture with neostigmine. Glycopyrrolate, administered in this way in a dose of 10 microgram/kg, is associated with stable heart rates.
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Anesthesia and analgesia · Aug 1981
Performance evaluation: continuous lumbar epidural anesthesia skill test.
The evaluation of skills in anesthesiology residents is usually subjective and lacks demonstrable reliability. Therefore, an objective criterion-referenced skill test for measuring performance of continuous lumbar epidural anesthesia was developed. For such a test to be useful, it is necessary to demonstrate agreement among rater-observers. ⋯ Inter-rater agreement was analyzed by determining coefficient kappa for each item and the entire test. Coefficient kappa for the entire test was 0.82 indicating a high degree of agreement between raters on the performance or nonperformance of various items. Development and utility of skill tests are discussed.
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Anesthesia and analgesia · Jul 1981
Comparative StudyVariations in onset of porcine malignant hyperthermia.
Variations in the onset of malignant hyperthermia were observed in five Poland China swine. These pigs were equivalently susceptible to malignant hyperthermia, based on the rapid onset in response to mask inhalation induction with halothane (five pigs) or sevoflurane (two pigs). A moderate dose of thiopental delayed the response to sevoflurane 10 minutes (one pig) and larger doses delayed it more than 60 minutes (two pigs). ⋯ These data suggest pancuronium as a relaxant of choice in anesthesia for susceptible subjects. Correlation with other data suggests that malignant hyperthermia may be difficult to initiate in subjects paralyzed by non-depolarizing relaxants in the absence of exposure to potent volatile agents. Thus the use of relaxant-induced paralysis might aid in the care of patients who develop recurrent malignant hyperthermia.