Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Apr 1989
Train-of-four fade during onset of neuromuscular block with nondepolarising neuromuscular blocking agents.
Fade in the train-of-four (TOF) responses during onset of neuromuscular block was studied following administration of atracurium (225 or 450 micrograms/kg), vecuronium (40 or 80 micrograms/kg), pancuronium (60 or 120 micrograms/kg) and tubocurarine (450 micrograms/kg). TOF ratios were measured at approximate heights of T1 (first response in the TOF) of 75, 50 and 25%. ⋯ The greatest difference between relaxants was observed at T1 of 25%, vecuronium showing the least fade and pancuronium, atracurium and tubocurarine showing increasing fade, in that order. The difference between atracurium and tubocurarine or between vecuronium and pancuronium was not significant, but the degree of TOF fade was significantly greater with atracurium and tubocurarine in comparison to vecuronium or pancuronium.
-
Acta Anaesthesiol Scand · Feb 1989
Randomized Controlled Trial Clinical TrialPropofol as an induction agent in children: pain on injection and pharmacokinetics.
The efficacy of lignocaine (1%) mixed with propofol in reducing pain on injection with propofol was studied in 40 children undergoing elective surgery in a double-blind, randomized comparison with glucose (5%). The pharmacokinetics of propofol in a single dose of 2.5 mg/kg was also studied in eight children participating in the same study. ⋯ The first-stage elimination half-life (t1/2 beta) of propofol in children was shorter (mean 9.3 +/- 3.8 (s.d.) min) than the values found in adults. This pharmacokinetic alteration may have clinical significance following repeated administration or continuous infusion of propofol.
-
The adverse effects of pain on acutely ill or traumatized patients are well documented. A variety of pain-relieving techniques are now available to meet the varied requirements for pain relief. ⋯ The block proved quick and simple to perform, with excellent clinical results of long duration and virtually no complications. Although not previously described, this single, large-volume injection approach to achieving an extensive thoracic paravertebral block may well become an important pain management technique in appropriate patients.
-
Acta Anaesthesiol Scand · Feb 1989
Comparative StudyEarly detection of inadvertent oesophageal intubation: pulse oximetry vs. capnography.
The aim of our retrospective study was to evaluate the efficacy of routine pulse oximetry and capnometry for detection of oesophageal tube misplacement. Patients undergoing ENT interventions at our hospital are routinely monitored by ECG, arterial blood pressure by cuff, capnography, and pulse oximetry. Beat-to-beat values of Sao2 and CO2 waveform were recorded by a graphic printer connected to a microcomputer, ASA I patients were routinely preventilated with FIO2 = 0.3, and ASA II-III patients with FIO2 = 1.0. ⋯ Oesophageal misplacement was detectable within 7.5 +/- 0.9 s in patients preventilated with FIO2 = 0.3 due to a 2.1 +/- 0.8% decrease in Sao2 (P less than 0.001). Our results underscore the significance of capnometry for rapid detection of inadvertent oesophageal intubation. High-resolution pulse oximetry is a valuable supplement but not a substitute for capnometry.
-
Acta Anaesthesiol Scand · Feb 1989
Early detection of the TUR syndrome by marking the irrigating fluid with 1% ethanol.
The ethanol concentration in the expired breath (EB-ethanol), the volumetric fluid balance and the serum sodium concentration were measured in the course of 60 transurethral resections of the prostate in which the irrigating fluid was 1.5% glycine + 1% ethanol. Measurement of EB-ethanol indicated absorption of irrigant at a rate of more than 150 ml in 10 min, as measured volumetrically. There was a significant direct linear relationship between EB-ethanol and the cumulative volume of irrigant absorbed (R2 = 0.83); this correlation was stronger when the duration of absorption was taken into account (R2 = 0.90). ⋯ Symptoms that are recognized components of the TUR syndrome developed in 8 of the 13 patients absorbing more than 11 of irrigant, while the ethanol exerted no adverse effects. The results of the study indicate that 1% ethanol is a suitable marker for monitoring irrigant absorption by means of the expired breath test in routine transurethral surgery. At this concentration the sensitivity of the test is adequate for detecting absorption, while the ethanol is less toxic than the irrigant fluid itself.