Journal of clinical anesthesia
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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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Randomized Controlled Trial Comparative Study Clinical Trial
Mivacurium as an alternative to succinylcholine during outpatient laparoscopy.
To compare (1) the adequacy of conditions for tracheal intubation; (2) the onset, depth, clinically effective duration, and recovery profile; and (3) adverse effects associated with mivacurium as an alternative to succinylcholine during general (endotracheal) anesthesia for outpatient laparoscopy. ⋯ Mivacurium 0.15 mg/kg given intravenously provided good to excellent conditions for tracheal intubation in 2 to 3 minutes. This dose provided a clinically effective duration of action of 20 to 25 minutes, and the residual blockade was readily reversible with neostigmine. Mivacurium did not, however, offer any apparent advantage over succinylcholine in this outpatient population.
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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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Comparative Study
A comparison of propofol, midazolam, and methohexital for sedation during retrobulbar and peribulbar block.
To compare the efficacy of propofol, methohexital, and midazalom in providing adequate sedation during administration of retrobulbar block and satisfactory postoperative amnesia. ⋯ Grimacing or verbal response during the retrobulbar or peribulbar block did not predict or correlate with patient recall. Propofol was equal to both midazolam and methohexital in providing adequate sedation and postoperative amnesia but possesses the added advantages of reduced postoperative vomiting, lower intraocular pressure, and earlier return-to-home readiness.
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Endoesophageal prostheses are sometimes used in palliative therapy of esophageal carcinoma. Placement or subsequent manipulation of these devices may require general anesthesia, and these anesthetics are fraught with potential complications, both from the patient's illness and from the prosthesis itself. The two patients in our report presented anesthetic challenges, including acute upper airway obstruction occurring outside the operating theater and management of malignant tracheoesophageal fistula.