European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of pancuronium and tubocurarine blocks by edrophonium or neostigmine: a comparative study.
Edrophonium 0.5 and neostigmine 0.05 mg kg-1 were compared as antagonists of pancuronium and tubocurarine-induced neuromuscular blocks, at varying degrees of recovery, in groups of 20 patients each. Adequate antagonism was defined as attaining a sustained train-of-four (TOF) ratio of 0.7 or more. Administration of edrophonium was associated with a more rapid onset of action (17 s with both relaxants with edrophonium, and 31 s and 29 s with neostigmine with pancuronium and tubocurarine, respectively), and a shorter time to attain a TOF ratio of 0.7 (74 s and 48 s with edrophonium and 230 s and 293 s with neostigmine for pancuronium and tubocurarine blocks, respectively). ⋯ Two separate groups of 10 patients each with relatively deeper pancuronium or tubocurarine blocks (three or less responses to TOF stimulation) were given edrophonium in a dose of 1.0 mg kg-1. However, adequate antagonism even with this dose of edrophonium was attained in only two out of 10 patients given pancuronium and in five out of 10 patients given tubocurarine. It is concluded that edrophonium is unreliable for antagonism of relatively deep blocks by pancuronium or tubocurarine and that neostigmine is the preferred and more reliable antagonist.
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Randomized Controlled Trial Clinical Trial
EMLA cream reduces the pain of venepuncture in children.
EMLA cream (eutectic mixture of local anaesthetics) was tested in a double-blind clinical trial to examine its effect on the pain of venepuncture at induction of anaesthesia in 40 children (aged 3-13 yrs). Four pain-assessment methods were used and an assessment of the technical ease of venepuncture was made. EMLA was found to reduce significantly the pain and technical difficulty of venepuncture. This study confirms that EMLA is an effective method of reducing the pain and technical difficulty of paediatric venepuncture using 25-gauge needles for induction of anaesthesia in children.