European journal of anaesthesiology
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Comparative Study Clinical Trial Controlled Clinical Trial
Neuromuscular effects of pipecuronium bromide.
The neuromuscular effects of pipecuronium bromide have been evaluated in 90 adult patients anaesthetized with thiopentone, nitrous oxide in oxygen and intravenous fentanyl with or without halothane. Eighty patients received pipecuronium 45 micrograms kg-1 and the remaining ten 70 micrograms kg-1. A separate group of 10 patients received pancuronium in a dose of 60 micrograms kg-1 (equipotent to pipecuronium 45 micrograms kg-1). ⋯ The time to onset of complete block with 70 micrograms kg-1 of pipecuronium averaged 2.5 min and the duration to 25% recovery 95 min. There were no significant changes in heart rate and arterial pressure with the use of pipecuronium. The results show pipecuronium to be a drug resembling pancuronium in its neuromuscular effects when used in equipotent doses.
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The accuracy of the Hemocue, a portable haemoglobinometer, was tested on 29 patients undergoing open-heart surgery, and the results were compared with the haemoglobin values obtained from the hospital laboratory. Special attention was paid to the lower range of haemoglobin values and the simplicity and speed of operating the meter. The correlation between the methods was good (r = 0.965). The limits of agreement were 0.0323 +/- 0.705 mmol l-1 (95% confidence level).
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Eighty-six patients completed a questionnaire about what they expected from a pre-operative visit by an anaesthesiologist. Ninety-one per cent of the patients wanted a detailed and informative conversation. The patient's previous knowledge stemmed primarily from lay sources, such as other patients and visitors. Age and marital status influenced the extent of the patient's previous knowledge.
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Fifty consecutive patients were studied prospectively to assess the effects of a continuous intravenous infusion of midazolam hydrochloride for sedation in patients requiring intensive care. Patient comfort was acceptable in all patients. However, to maintain the same degree of sedation it was necessary to increase the daily dose of midazolam indicating that benzodiazepine tolerance may have been developing. ⋯ Two patients with combined hepatic and renal failure took 124 and 140 h to awaken. Continuous intravenous infusion of midazolam offers good patient comfort but increasing dose requirements in critically ill patients may lead to drug accumulation and delayed awakening. The risks of cumulation may be increased if the drug is given by continuous infusion for prolonged periods without intermittent assessment of the patient's conscious state.
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SPINA is a program developed with LOTUS 1-2-3 that simulates the pharmacokinetics of an infusion of intravenous anaesthetic drugs. SPINA incorporates a database which contains records of multiple-compartment pharmacokinetic models. The models have been obtained from the literature. ⋯ To perform the pharmacokinetic simulation, the anaesthetist has to choose a pharmacokinetic model in which the program determines the turn-over rates, and displays a sequence of infusion steps. On request, SPINA provides the graphs for the theoretical drug distribution and for the infusion rate required to maintain the target concentration. SPINA therefore allows one to simulate the administration of intravenous anaesthetic drugs and to optimize their delivery.