Anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesic effect of intrathecal neostigmine and its influence on spinal anaesthesia.
A clinical trial was conducted to evaluate the postoperative analgesic efficacy and the safety of intrathecal neostigmine in patients undergoing anterior and posterior vaginoplasty under spinal anaesthesia. Thirty-six patients were randomly divided into three groups to receive: normal saline (1 ml), morphine (100 micrograms in 1 ml of saline) or neostigmine (100 micrograms in 1 ml of saline) intrathecally just before a spinal injection of hyperbaric bupivacaine (0.5%, 4 ml). The mean [SD] time to the first analgesic (nonsteroidal anti-inflammatory drug) administration was significantly prolonged by intrathecal neostigmine (10.7 [4.3] h) and morphine (15.3 [3.0] h) compared with saline (4.5 [1.0] h). ⋯ Severe nausea and vomiting, sweating and distress during surgery were the most obvious adverse effects of intrathecal neostigmine. On the other hand, less hypotension was observed in the neostigmine group. The usefulness of intrathecal neostigmine as the sole postoperative analgesic may be restricted by the severity of its adverse effects.
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Randomized Controlled Trial Clinical Trial
Factors affecting neostigmine reversal of vecuronium block during sevoflurane anaesthesia.
We examined the influence of the concentration of sevoflurane and the degree of muscle block at the time of reversal on the activity of neostigmine. Ninety ASA 1-2 patients were anaesthetised with 0.2, 0.7 or 1.2 MAC of sevoflurane (30 patients each) in 66% nitrous oxide in oxygen. The electromyographic (EMG) response of the adductor digiti minimi was monitored at 20-s intervals after train-of-four stimulation of the ulnar nerve. ⋯ Higher endtidal concentrations (p < 0.0001) and more pronounced block at the time of reversal (p < 0.0001) were associated with a delayed recovery in the train-of-four ratio. In addition, the train-of-four ratio 15 min after neostigmine administration was more dependent on the sevoflurane concentration than on the degree of block present (p < 0.0001). These results confirm that neostigmine (40 micrograms.kg-1) can reverse vecuronium-induced but not sevoflurane-induced neuromuscular block.
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In 10 cases of unexpected difficult tracheal intubation using the Macintosh laryngoscope blade, the larynx could not be seen. In each case, a good view was achieved using the Miller blade lateral to the tongue, which enabled tracheal intubation under direct vision. The results achieved using narrow, low-profile straight laryngoscope blades with this technique are reviewed. ⋯ Paraglossal straight blade laryngoscopy may have an advantage over use of the Macintosh technique when intubation proves unexpectedly difficult. It is perhaps time to question standard teaching about the role of the curved blade in such patients or, more particularly, whether the technique of laryngoscopy as currently taught is optimal. The paraglossal straight blade technique needs to be practised in routine intubation before it can be used with confidence in difficult cases.