British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Controlled comparison of a new sublingual lormetazepam formulation and i.v. diazepam in outpatient minor oral surgery.
In a randomized, double-blind, parallel groups study, 40 patients undergoing surgical removal of impacted 3rd molar teeth received either sublingual lormetazepam 2.5 mg (n = 20) in a new cellulose wafer formulation followed at 35 min by i.v. saline; or sublingual placebo followed at 35 min by i.v. diazepam 10 mg (Diazemuls). Rapid onset of sedation was seen after sublingual lormetazepam, while the course and duration of postoperative sedation, measured using standard psychometric tests, was similar following both treatments. ⋯ Both treatments were tolerated well, with no significant cardiovascular complications. These results indicate that sublingual lormetazepam may have a role in anaesthesia as a premedicant and for conscious sedation.
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Neuromuscular blockade was obtained with vecuronium 108 micrograms kg-1 in 44 patients undergoing diagnostic muscle biopsy as part of an investigation of malignant hyperthermia (MH) susceptibility. At the termination of anaesthesia doxapram 1.43 mg kg-1 was given in an attempt to antagonize postoperative respiratory depression. Rectal, muscle and skin temperatures, blood lactate concentration and venous PCO2 were measured before, during and after anaesthesia. ⋯ There were no differences between the three groups in rectal or muscle temperature, blood lactate concentration or venous PCO2 at any time. Doxapram did not prevent an increase in postoperative PCO2. It is concluded that vecuronium and doxapram may be safely administered to patients susceptible to MH.
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Comparative Study Clinical Trial Controlled Clinical Trial
Intraocular pressure changes during rapid sequence induction of anaesthesia: comparison of propofol and thiopentone in combination with vecuronium.
Intraocular pressure (IOP) was measured during rapid sequence induction of anaesthesia using thiopentone or propofol as the induction agent and vecuronium for neuromuscular blockade. Vecuronium was administered in a dose of 0.15 mg kg-1 approximately 35 s before the induction agent. IOP was measured with a handheld applanation tonometer before anaesthesia, following administration of the induction agent, immediately after tracheal intubation and cuff inflation and 1, 2 and 3 min later. ⋯ IOP following intubation in patients in whom anaesthesia was induced with thiopentone was not significantly different from baseline values, but showed a significant increase from the pressure before intubation. In contrast, IOP after intubation in the propofol group remained not only significantly less than the baseline value, but also showed only a minimal and insignificant change in comparison with values before intubation. The frequency of side effects was low in both groups except for a significantly greater reduction in arterial pressure in those receiving propofol.
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The effect of the i.v. administration of methylene blue dye on haemoglobin oxygen saturation, measured by a pulse oximeter was investigated. The absorption spectra of various concentrations of haemoglobin, oxyhaemoglobin and methylene blue were compared. The amount of 660-nm light absorbed by methylene blue was sufficient to cause a factitious haemoglobin desaturation as measured by the pulse oximeter.