Journal of clinical anesthesia
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The intraoperative monitoring of neuromuscular blockade usually involves measurement of the muscular responses to motor nerve stimulation. Although researchers have the time and technology to obtain predrug control measurements of the twitch responses, these are seldom available to the clinician. ⋯ Concentrations in the effect compartment associated with these two extremes of the TOF count are combined with concentration-time profiles of vecuronium with various dose regimens. This study models the effect compartment concentrations associated with vecuronium-induced paralysis, combining them explicitly with the range of concentrations associated with the TOF count to demonstrate the kinetic mechanisms underlying the time-course of paralysis.
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Randomized Controlled Trial Clinical Trial
Reduction of propofol injection pain with a double lumen i.v. set.
To investigate if the use of a new double lumen i.v. set (DLIS) decreases the incidence of propofol injection pain compared with single lumen i.v. set (SLIS) administration. ⋯ The DLIS significantly reduced the incidence of propofol injection pain compared with SLIS. Further studies are indicated to evaluate the cost-effectiveness of this device.
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Randomized Controlled Trial Clinical Trial
Intrathecal neostigmine for postoperative analgesia after orthopedic surgery.
To establish a dose-response curve for the analgesic effect of intrathecal neostigmine in patients undergoing below knee surgery with spinal anesthesia. To assess adverse effects, principally nausea and vomiting. ⋯ Intrathecal neostigmine produced a dose-independent analgesia and a dose-dependent incidence of adverse effects with the doses studied.
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For more than 40 years, succinylcholine has been the traditional choice of muscle relaxant to facilitate tracheal intubation, particularly for anesthesia in the emergency patient with a full stomach. This presentation reviews factors that determine the onset of neuromuscular blockade, particularly with regard to tracheal intubation. Measurement of neuromuscular block, both clinical and via nerve stimulators, is described and compared, and correlations with intubating conditions are attempted. ⋯ None of the currently available drugs, or those undergoing clinical investigation, possesses the rapid onset and prompt recovery of succinylcholine. Despite the formidable side effect profile of succinylcholine, it has not been replaced by a nondepolarizing agent for use in emergency conditions. However, the alternatives, particularly rocuronium and mivacurium, are drugs with a greater safety profile that, in many circumstances, can substitute for succinylcholine.
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The pharmacokinetic and pharmacodynamic interactions between opioids and propofol increasingly have been described and used in clinical practice. It is now known that propofol inhibits both alfentanil and sufentanil metabolism, thereby increasing the plasma concentrations of these opioids, while alfentanil also elevates propofol concentrations. ⋯ From the interaction data, the optimal propofol concentrations have been extracted that assure adequate anesthesia and the most rapid recovery possible. In the presence of fentanyl, sufentanil, and alfentanil, the optimal propofol concentration is approximately 3.5 microgram/ml, whereas in the presence of remifentanil, lower propofol concentrations of 2.5 to 3 microgram/ml are required.