British journal of anaesthesia
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We prospectively studied spontaneous recovery from cisatracurium-induced neuromuscular block in 18 patients scheduled for cardiac surgery, and its suitability for fast-track cardiac surgery. Neuromuscular block was induced by an i.v. bolus (range 0.15-0.3 mg kg(-1)) and maintained by a continuous infusion (range 1.1-3.2 microg kg(-1) min(-1)) of cisatracurium until sternal closure. In the intensive care unit (ICU), spontaneous recovery was evaluated by the train-of-four (TOF) ratio measured at the adductor pollicis muscle. ⋯ Fifteen patients (83%) were successfully extubated during the first 8 h after stopping the cisatracurium infusion. Only one patient showed residual paralysis when sedation was discontinued. These results support the use of cisatracurium as a suitable neuromuscular blocking agent for fast-track cardiac surgery.
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Randomized Controlled Trial Clinical Trial
Sedative, analgesic and cognitive effects of clonidine infusions in humans.
This placebo-controlled, randomized study evaluated, on separate days, the dose-response relationship for 1 h infusions of clonidine 1, 2 and 4 microg kg(-1) h(-1), in eight healthy volunteers aged 22-30 yr. Response end-points included sedation (bispectral index, visual analogue scale and observer assessment of sedation), analgesia to a cold pressor test, memory (recall of word lists), cognitive function (digit symbol substitution test (DSST)), respiratory function (respiratory rate, end-tidal carbon dioxide, oxygen saturation) and haemodynamic stability (heart rate and mean arterial pressure). ⋯ Statistically significant analgesia, memory impairment and reduced performance on the DSST occurred during 4 microg kg(-1) h(-1) infusions (resulting in a plasma concentration of 2 ng ml(-1). There were no statistically significant changes in cardiorespiratory variables throughout the study.
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We studied how head and neck position affect the cuff position and oropharyngeal sealing pressures of the laryngeal mask airways (LMAs) in children. We studied 39 non-paralyzed healthy children aged 1.5-8.0 yr, weighing 10.3-27.0 kg, managed with size 2 or 2.5 LMAs during elective surgery. ⋯ Oropharyngeal sealing pressure was significantly greater during neck flexion compared with the neutral position (P<0.02). Fibreoptic examination revealed that the epiglottis covered a larger area of the LMA aperture during neck flexion, compared with the neutral position (P<0.02).