British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Effects of different doses of thiopentone on the increase in serum myoglobin induced by suxamethonium in children.
We have studied the effects of different doses of thiopentone on the increase in serum myoglobin after administration of suxamethonium during inhalation induction of anaesthesia in children. Forty-three children were anaesthetized with halothane and nitrous oxide in oxygen and allocated to four groups: group S received suxamethonium 1 mg kg-1 to facilitate intubation; group ST2 received thiopentone 2 mg kg-1 and group ST4 received thiopentone 4 mg kg-1, before administration of suxamethonium 1 mg kg-1; group N did not receive thiopentone or suxamethonium. Serum myoglobin and creatine kinase (CK) concentrations were measured until 60 min after the injection of suxamethonium. ⋯ In group N, both values remained reasonably constant. Thiopentone 4 mg kg-1, but not 2 mg kg-1, attenuated the increase. The results indicate that to prevent a marked elevation in serum myoglobin after administration of suxamethonium, thiopentone 4 mg kg-1 should be administered.
-
Ten healthy patients and 25 patients with cirrhosis of the liver (10 Child's A, 10 Child's B and 5 Child's C) received a bolus dose of mivacurium chloride 150 micrograms kg-1. The electromyographic response was monitored throughout anaesthesia until recovery of the first twitch of the train-of-four (TOF) (T1/T0) to at least 85% and the TOF ratio (T4:T1) to at least 80%. There was no significant difference between the two groups in the onset of neuromuscular block, but recovery was prolonged in the cirrhotic group compared with the healthy patients (respective mean times to recovery of T1/T0: to 5% = 20.2 vs 11.2 min (P < 0.05); to 10% = 23.8 vs 13.4 min (P < 0.005); to 25% = 28.4 vs 16.6 min (P < 0.005); to 50% = 41.1 vs 20.1 min (P < 0.005); to 75% = 43.8 vs 24.9 min (P < 0.005). ⋯ Recovery was most prolonged in the Child's C patients. Mean plasma cholinesterase activity was less in the cirrhotic compared with the healthy group (mean 582 (SD 254) iu litre-1 vs 1125 (303) iu litre-1) (P < 0.001) and there was a significant negative correlation between plasma cholinesterase activity and all the indices of recovery (P < 0.001 for all except recovery index (P < 0.01)). We conclude that patients with hepatic cirrhosis may be sensitive to mivacurium, which could be explained, at least in part, by the lesser plasma cholinesterase activity.
-
We have examined the time course of, and relationship between, primary and secondary hyperalgesia after thermal injury to the skin in humans. Burn injuries (15 x 25 mm rectangular thermode, 49 degrees C, 5 min) were produced in eight healthy, unmedicated male volunteers, on the medial side of the right calf, on two occasions at least 8 days apart. Heat pain detection thresholds (HPDT), heat pain tolerance (HPT), mechanical pain detection threshold (MPDT) and the intensity of burn-injury induced erythema (skin erythema index, SEI) were assessed inside the burn injury. ⋯ The time course of the intensity of primary hyperalgesia was related closely to that of changes in area of secondary hyperalgesia, and hyperalgesia outside the injury did not outlast hyperalgesia inside the injury in any volunteer. These findings suggest post-injury development of secondary hyperalgesia to be a dynamic process, closely related in time to a peripheral nociceptive input, with reversal to normal when the peripheral lesion disappears. These observations may be relevant to the concept of "pre-emptive" analgesia.
-
Randomized Controlled Trial Clinical Trial
IV clonidine for post-extradural shivering in parturients: a preliminary study.
We have studied the efficacy of i.v. clonidine to suppress post-extradural shivering in parturients. Forty healthy parturients who received extradural block for labour (n = 20) or for Caesarean section (n = 20) and who required treatment for shivering after delivery were allocated randomly to two groups. Group I received i.v. clonidine 30 micrograms diluted in saline to a total volume of 5 ml (therapeutic solution). ⋯ When patients in the placebo group received clonidine, improvement occurred. Arterial pressure, heart rate, core and peripheral temperature and oxygen saturation did not differ significantly between and within the groups before and after administration of clonidine. We conclude that a small dose of i.v. clonidine may be useful to suppress post-extradural shivering in parturients.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Teaching fibreoptic nasotracheal intubation with and without closed circuit television.
We have compared the progress of anaesthetists taught fibreoptic nasotracheal intubation with the aid of a closed circuit television (CCTV) system with that of anaesthetists taught by traditional methods. Twenty anaesthetists were allocated randomly to either the video or traditional training group. A graduated training programme was used in which the first stage was an introduction to techniques and apparatus and the second stage was practice on an airway model. ⋯ All the video-controlled intubations were successful. There was no significant difference between the number of successful traditional intubations in the two groups (90% video, 92% traditional). CCTV appears to enhance substantially the rate of acquisition of fibreoptic nasotracheal intubation skills.