British journal of anaesthesia
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We discontinued temporarily an infusion of propofol for surgical reasons in 20 patients undergoing incontinence surgery. The patients, who had not received neuromuscular blockers, were allowed to regain consciousness to a level enabling them to cough on command, open their eyes, and identify and verbally confirm a randomly assigned digit shown on paper. Thereafter, 5-14 min after discontinuation of the propofol infusion, anaesthesia was reinstituted. ⋯ Only 35% of patients were able to recall one or more of the stimuli presented during wakefulness or were even able to recall having been "awake", and there were very few differences in memory on the day after surgery compared with 1 h after anaesthesia. In comparison with corresponding stimuli given before anaesthesia, memory of material learned during wakefulness was significantly impaired (P < 0.0001). Thus patients temporarily capable of cognitive action during propofol anaesthesia may have no subsequent explicit recall of intraoperative events.
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We have examined the effects of sedation with midazolam 0.1 mg kg-1 and reversal with flumazenil 0.5 mg on beat-to-beat heart rate (HR) variability (HRV), systolic arterial pressure (SAP), finger photoplethysmograph amplitude (PLA) and impedence pneumography in eight volunteers. With the onset of sedation there was a small decrease in SAP and increase in HR (ns). ⋯ These were thought to be secondary to activity of coupled cardiorespiratory neurones within the brain stem and the ventilatory periodicity appeared similar to that observed during the early stages of sleep. The diminished high frequency and increased low frequency oscillations induced by midazolam sedation were reversed by administration of flumazenil.
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Editorial Review
Rocuronium: the newest aminosteroid neuromuscular blocking drug.
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Randomized Controlled Trial Comparative Study Clinical Trial
Rocuronium pretreatment reduces suxamethonium-induced myalgia: comparison with vecuronium.
We have studied, in 150 patients undergoing elective oral surgery, the effectiveness and sequelae of pretreatment with rocuronium for reducing myalgia after suxamethonium. Patients were allocated randomly to one of three groups: anaesthesia was induced with propofol and fentanyl, and group V received vecuronium 1 mg, group R rocuronium 6 mg and group P placebo pretreatment. Suxamethonium 1.5 mg kg-1 was given 60 s after the pretreatment agent. ⋯ The incidence of postoperative myalgia on day 1 after rocuronium (20%) was significantly less than after vecuronium (42%) (P < 0.05) or placebo (70%) (P < 0.01). By day 4 the incidence of myalgia was 28.6% in the rocuronium group, 46.3% in the vecuronium group and 95% in the placebo group. Intubating conditions were not affected adversely by any pretreatment regimen.