British journal of anaesthesia
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We simultaneously determined the neuromuscular blocking effect of mivacurium 0.2 mg kg(-1) at five muscles in 20 women undergoing gynaecological surgery. Evoked electromyographic responses were obtained using surface electromyography (EMG) at the adducting laryngeal muscles, the diaphragm (lateral to vertebrae T12/L1 or L1/L2) and the adductor pollicis muscle and acceleromyographic (AMG) responses were measured at the orbicularis oculi and the corrugator supercilii muscle. ⋯ Onsetand clinical duration of neuromuscular block at the larynx and the diaphragm after mivacurium 0.2 mg kg(-1) are shorter than in the peripheral muscles. Monitoring of neuromuscular block in the diaphragm was successfully used in all patients.
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One hundred and forty-three students and 18 faculty at the University of Toronto participated in a study of the anaesthesia simulator as an evaluation tool. Both student and faculty opinions regarding the experience were elicited using questionnaires with a five-point scale, 1 = strongly disagree, 5 = strongly agree. Faculty and student opinion were similar and positive with respect to the use of the simulator and matching of educational objectives, its use as a learning experience, its use as an evaluation tool and the need for familiarity with the tool before use as an assessment method. This study supports the use of the simulator as an evaluation tool based on faculty and student opinions provided that prior exposure to the environment is offered.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of remifentanil compared with fentanyl on intraocular pressure after succinylcholine and tracheal intubation.
Rapid sequence induction using succinylcholine is associated with an increase in intraocular pressure (IOP). This may lead to loss of ocular contents in open globe injuries. No method has previously been shown to prevent this increase in IOP. ⋯ Forty-five patients were randomized blindly to receive remifentanil 1 microgram kg-1, fentanyl 2 micrograms kg-1 or placebo 1 min before thiopental, succinylcholine and tracheal intubation. IOP and haemodynamic variables were measured before, 1 min after the test solution, 30 s after thiopental, 30 s after succinylcholine, immediately after intubation and then every 3 min for 9 min. Remifentanil obtunded the increase in IOP after succinylcholine and intubation, so it could be suitable for use in open globe injuries.