Journal of clinical anesthesia
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With the continued use of alpha-2-adrenergic agonists in anesthetic practice, careful attention should be given to the potential for drug interactions. Based on a review of the basic and applied pharmacology of this class of compound, we have made recommendations for the safe and efficacious use of alpha-2-adrenergic agonists in the clinical setting.
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Review Comparative Study
Clinical pharmacology of mivacurium chloride: a review.
Mivacurium chloride (Mivacron) is a new benzylisoquinolinium choline-like diester neuromuscular blocking drug with an onset of action at equipotent doses that is comparable to atracurium and vecuronium but slower than succinylcholine. Its clinical duration (injection-25% recovery and injection-95% recovery) is twice that of succinylcholine but one-half to one-third that of atracurium and vecuronium. Mivacurium is easy to use as a continuous infusion and when used this way its recovery characteristics are unchanged. ⋯ In these patients and those with acquired deficiencies, mivacurium should not be used. The duration of action in elderly patients is comparable to that in the young, while in prerenal transplant patients, its duration is prolonged by about 50%, and in prehepatic transplant patients, duration of block is increased threefold. Mivacurium possesses the advantages of short duration, unchanged recovery characteristics following infusions (without phase II block or tachyphylaxis), and precise control.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
Management of a severed endotracheal tube during LeFort osteotomy.
An unusual but serious case in which the endotracheal tube was severed during LeFort osteotomy is presented. The aspects of the surgery that can create this problem are reviewed. Past literature is reviewed, and various procedures for the management of this problem, including the plan followed in this case, are discussed.
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Review Case Reports
Apparent focal motor seizure with a jacksonian march induced by fentanyl: a case report and review of the literature.
This report describes an unusual presentation of focal motor activity resembling Jacksonian march, which developed during fentanyl induction of general anesthesia. Simultaneous spectral-edge activity recording of electroencephalography (EEG) failed to show evidence of an epileptic focus. A negative history of previous seizures, as well as failure to show postoperative postictal symptoms or seizure activity by 16-lead EEG, suggested a myoclonic rather than epileptic nature of the observed muscle activity. Pertinent literature and current theories regarding opioid-induced seizures are discussed.