Anaesthesia
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Randomized Controlled Trial Clinical Trial
Postoperative residual block after intermediate-acting neuromuscular blocking drugs.
The frequency and duration of postoperative residual neuromuscular block on arrival of 150 patients in the recovery ward following the use of vecuronium (n = 50), atracurium (n = 50) and rocuronium (n = 50) were recorded. Residual block was defined as a train-of-four ratio of <0.8. An additional group of 10 patients received no neuromuscular blocking drugs during anaesthesia. ⋯ None of the 10 patients who did not receive neuromuscular blocking drugs had train-of-four ratios <0.8 on arrival in the recovery ward. It is concluded that a large proportion of patients arrive in the recovery ward with a train-of-four ratio <0.8, even with the use of intermediate-acting neuromuscular blocking drugs. Although the residual block is relatively short lasting, it may occasionally be prolonged, requiring close observation and monitoring of such patients in the recovery ward.
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Regional anaesthesia has seen the development of a new local anaesthetic: levobupivacaine. This review aims to outline the rationale underlying the development of levobupivacaine and to consider its place in modern regional anaesthesia.
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This re-survey of neurosurgical centres was conducted to determine whether the publication of management guidelines has resulted in changes in the intensive care management of severely head-injured patients (defined as Glasgow Coma Score < 9) in the UK and Ireland. Results were compared with data collected from a similar survey conducted 2 years earlier. ⋯ More centres maintain core temperature < 36.5 degrees C. Although wide variations in the management of severely head-injured patients still exist, we found evidence of practice changing to comply with published guidelines.
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To determine the effect of halothane on the cerebral blood flow velocity (CBFV) with increasing then decreasing concentrations, 11 children scheduled for minor surgery were studied. Anaesthesia consisted of halothane, vecuronium, nitrous oxide in oxygen and a caudal block. ⋯ During the decreasing phase, CBFV decreased significantly from 1.5 to 1.0 MAC of halothane (p <0.001), whereas there was no difference in CBFV when decreasing halothane MAC from 1.0 to 0.5 MAC. In children, the decrease in CBFV during decreasing halothane concentration is not superimposable to the increase in CBFV seen when increasing halothane concentration, suggesting the presence of cerebrovascular hysteresis to halothane.