Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Single-dose spinal anesthesia with a mixture of isobaric bupivacaine 0.5% and hyperbaric mepivacaine 4%].
Single-dose spinal anaesthesia with hyperbaric local anaesthetic provides profound analgesia and motor blockade and allows exact assessment of the analgesic level. The present prospective, randomised study compares a mixture of plain 0.5% bupivacaine and hyperbaric 4% mepivacaine with hyperbaric 0.5% bupivacaine with regard to onset time of analgesia and duration of the sensory and motor blockade. ⋯ The local anaesthetic mixture may be preferred to hyperbaric 0.5% bupivacaine in patients requiring a fast onset of analgesia associated with a 2-3 h duration of sensory and motor block.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[Neostigmine and edrophonium. Antagonism of profound and shallow mivacurium blockade].
Mivacurium has a short duration of action because it is rapidly hydrolysed by plasma cholinesterase. There is ongoing controversy concerning the antagonism of mivacurium-induced neuromuscular block, firstly because of its short spontaneous recovery time, and secondly because the metabolism of mivacurium may be inhibited by anticholinesterases. We therefore compared neostigmine and edrophonium reversal of deep and moderate mivacurium-induced blocks. ⋯ Two theoretical reasons, the very rapid onset time and the fact that it does not inhibit plasma cholinesterase, suggest edrophonium to be the preferred antagonist of a mivacurium-induced blockade. These two characteristics are reflected in our results: only edrophonium was able to shorten the recovery index significantly and, administered at a profound level of mivacurium-induced neuromuscular block, only edrophonium was successful in shortening recovery time significantly. Therefore, edrophonium should be the anticholinesterase of choice to antagonise a mivacurium-induced neuromuscular block.