British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Intubating conditions and time course of rocuronium-induced neuromuscular block in children.
We have investigated the potential of rocuronium 0.6 mg kg-1 (2xED95) and 0.9 mg kg-1 (3xED95) for rapid sequence induction in 100 children, aged 3-7 yr. Intubating conditions with the two different doses of rocuronium were assessed in 70 children (n = 35 in each group) undergoing elective surgery. Intubation was carried out by mimicking rapid sequence induction, and intubation conditions were evaluated according to a standard score. ⋯ Three times the ED95 induced deeper neuromuscular block, 1 min after injection compared with 2xED95 (twitch height: 42 (24) vs 25 (19)%, respectively; P < 0.05). The same was true for onset time (193 (47) vs 118 (23) s; P < 0.01), clinical duration (21 (4) vs 34 (11) min; P < 0.01) and duration to 75% recovery (30 (6) vs 44 (4) min; P < 0.01). By mimicking rapid sequence induction, both doses of rocuronium offered clinically acceptable (good or excellent) intubating conditions.
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Randomized Controlled Trial Clinical Trial
Effect of oral antihistamine premedication on mivacurium-induced histamine release and side effects.
In this randomized, double-blind, placebo-controlled study, we have examined histamine release, haemodynamic and cutaneous effects of mivacurium administered in low (0.105 mg kg-1 = 1.5 x ED95) and high (0.21 mg kg-1 = 3 x ED95) doses and assessed if oral pretreatment with H1/H2 antagonists would blunt the effects of mivacurium-induced histamine release. Patients received either ranitidine 300 mg and dimethindene 0.1 mg kg-1 (H1 blocker) or placebo, orally 1 h before induction of anaesthesia. Twelve patients were allocated to each group. ⋯ Plasma concentrations of histamine increased significantly in five patients in the placebo group after high-dose mivacurium and the mean value was increased. There was no consistent correlation between haemodynamic changes, cutaneous manifestations and histamine concentrations. Significant cardiovascular reactions occurred in six patients in the placebo groups and in only one patient treated with antihistamines.
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Randomized Controlled Trial Clinical Trial
Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effect of site of injection on spread of analgesia.
In this randomized, observer-blind study, we have examined, in elderly patients, the effect of site of injection on analgesia levels after spinal injection of 0.5% hyperbaric bupivacaine solution. Thirty male patients, aged 68-87 yr, undergoing minor urological surgery during spinal anaesthesia received 3 ml of a 0.5% hyperbaric bupivacaine solution at either the L3-4 (n = 15) or L4-5 (n = 15) interspace. The solution was injected with the patient in the sitting position. ⋯ The highest analgesia levels did not differ between groups (medians were approximately T7). There were no significant differences in the time to maximum cephalad spread of analgesia, maximum degree of motor block or haemodynamic changes. We conclude that injection at the L4-5 interspace has no advantage compared with injection at the L3-4 interspace.
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Randomized Controlled Trial Comparative Study Clinical Trial
Edrophonium and human plasma cholinesterase combination for antagonism of mivacurium-induced neuromuscular block.
We have compared the reversal characteristics of mivacurium after administration of an edrophonium-plasma cholinesterase (PCHE) combination with that produced by each antagonist alone. Forty ASA I adults were given mivacurium 0.15 mg kg-1 during fentanyl-thiopentone-nitrous oxide-isoflurane anaesthesia. TOF stimulation was applied to the ulnar nerve every 12 s, and the force of contraction of the adductor pollicis muscle was recorded. ⋯ This was shorter (P < 0.01) than that observed in patients in the control (16.8 (3.3) min), ED (8.9 (3.6) min) and PCHE (9.3 (1.6) min) groups. There was no difference in recovery indices between groups ED and PCHE. We have demonstrated that the edrophonium-PCHE combination significantly accelerated recovery of mivacurium-induced block compared with that observed with the use of individual antagonists.
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Randomized Controlled Trial Clinical Trial
Influence of patient position on withdrawal forces during removal of lumbar extradural catheters.
We have investigated the force required to remove lumbar extradural catheters from 88 parturients to determine the effects of patient positioning at removal, relative to the position at insertion. Parturients were allocated randomly to one of four groups: LS (lateral insertion, sitting withdrawal), LL (lateral insertion, flexed lateral withdrawal), SL (sitting insertion, lateral withdrawal) or SS (sitting insertion, sitting withdrawal). ⋯ We found that the withdrawal force was influenced by the relationship between the position at removal and that at insertion, and we recommend that for ease of removal, patients should be placed in the same position as they were at the time of insertion. Compared with all other groups, the withdrawal force in patients in group LS was significantly greater (P < 0.05).