European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Nausea and vomiting after general anaesthesia with isoflurane, enflurane or fentanyl in combination with nitrous oxide and oxygen.
One-hundred and eighty patients undergoing elective abdominal hysterectomy were anaesthetized in random order with isoflurane, enflurane or fentanyl in combination with nitrous oxide and oxygen. Incidence and severity of emetic sequelae (none, nausea, retching or vomiting) were studied during the first 24 h after the operation. ⋯ There was no difference between the groups in the overall incidence of emetic sequelae during the time period of 2-24 h post-operatively (isoflurane 65%, enflurane 77% and fentanyl 77%). Significantly (P less than 0.02) more patients had emetic sequelae if they had experienced nausea or had vomited after previous anaesthetics.
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Clinical Trial Controlled Clinical Trial
Serum myoglobin following tourniquet release under anaesthesia.
Serum myoglobin concentrations were studied in 34 patients during tendon and nerve reconstruction operations that required the application of a pneumatic limb tourniquet. Seventeen patients received general anaesthesia without the use of suxamethonium, while the remaining 17 were given suxamethonium as part of the anaesthetic technique. Tourniquet times of up to 2.5 h were associated with negligible myoglobin release, but the use of suxamethonium administration resulted in a rise of serum myoglobin in some subjects, reaching a maximum of 300 micrograms litre-1 20-40 min after induction. ⋯ Three of the four patients who required a re-application of the tourniquet (after a short reperfusion time) had rises of serum myoglobin up to 120 micrograms litre-1 following the second deflation. Pneumatic tourniquets appear to cause no detectable ischaemic damage for up to 2.5 h, with or without prior use of suxamethonium. Re-application after only a short period of reperfusion may be inadvisable.
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Comparative Study
Comparison of evoked electromyography and mechanical activity during vecuronium-induced neuromuscular blockade.
The relationship of compound electromyography to mechanical myography was investigated in 20 patients given vecuronium in a dose of 0.1 mg kg-1. Mechanical response was affected less quickly and recovered faster than the electrical response. ⋯ Moreover, during recovery the mechanical responses became greater than the control value in all patients. This was also reflected in the statistically significant difference (P less than 0.05) of the regression lines relating tension and electromyography (TI as well as train-of-four ratio) between onset of, and recovery from, neuromuscular block.
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Randomized Controlled Trial Comparative Study Clinical Trial
Accelerated onset of non-depolarizing neuromuscular blocking drugs: pancuronium, atracurium and vecuronium. A comparison with succinylcholine.
The time of onset and degree of neuromuscular blockade (NMB) in 80 anaesthetized patients, following either a single bolus injection of pancuronium 0.95 mg kg-1, atracurium 0.53 mg kg-1 or vecuronium 0.07 mg kg-1, or divided doses of pancuronium 0.15 mg kg-1, atracurium 0.07 mg kg-1 or vecuronium 0.01 mg kg-1 administered 3 min or 5 min before the second dose of pancuronium 0.08 mg kg-1, atracurium 0.46 mg kg-1 or vecuronium 0.06 mg kg-1, were determined and compared to the same parameters measured following succinylcholine administration (1 mg kg-1). The time to maximum NMB (100%) following the administration of succinylcholine was 58.1 +/- 5.3 s, whereas the time to maximum NMB (100%) following a single bolus injection of either pancuronium, atracurium or vecuronium was 130.6 +/- 22.2, 93.0 +/- 6.4, 127.5 +/- 13.0 s, respectively. ⋯ However, when the two doses of drug were separated by 5 min, only small, non-significant further decreases occurred in the time required to achieve maximum blockade. Although the time to maximum NMB following divided doses of pancuronium, atracurium or vecuronium is significantly longer than that for succinylcholine, divided dosing significantly decreases the time required to reach maximal NMB.
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Comparative Study Clinical Trial Controlled Clinical Trial
Assessment of neuromuscular block: comparison of three clinical methods and evoked electromyography.
Three clinical methods, visual, tactile and 'spring', for the assessment of neuromuscular blockade were compared to the EMG recording evoked during enflurane anaesthesia and relaxation with vecuronium in 33 patients. During maintenance of the block, the tactile method, based on the recognition of the strength of movement of the patient's thumb against the observer's fingers, was more accurate than the two other methods. The correlation coefficient compared to the TI of the EMG was 0.77. ⋯ Using the spring, a clinically significant residual fade (TOF less than 0.50) could be detected in nine of the 11 cases. As residual relaxation cannot be ruled out using the clinical methods, quantitative recording of neuromuscular function is recommended in cases where complete recovery from muscle relaxation is of special importance. The spring method is the most reliable clinical method during recovery, while the tactile method is the most accurate during the maintenance of neuromuscular block.