British journal of anaesthesia
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We have studied the neuromuscular effects of pipecuronium, vecuronium and their combination in 130 ASA group I or II patients. Patients were anaesthetized with 0.8% halothane and 60% nitrous oxide in oxygen. Neuromuscular block was recorded as the evoked thenar mechanomyographic response to train-of-four stimulation of the ulnar nerve (2 Hz at 10-s intervals). ⋯ The calculated doses producing 50% depression of the first twitch height were 15.6, 16.9 and 15.0 micrograms kg-1 for the pipecuronium, vecuronium and pipecuronium-vecuronium combination groups, respectively. Isobolographic and algebraic (fractional) analyses were used to assess quantitatively the combined neuromuscular effect of pipecuronium and vecuronium and to define the type of interaction between these drugs. The interaction between pipecuronium and vecuronium was found to be additive.
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Randomized Controlled Trial Comparative Study Clinical Trial
Presurgical analgesia in children subjected to hypospadias repair.
We have examined the use of different pre-surgical analgesic techniques in 30 children aged 2-10 yr undergoing repair of hypospadias. They were allocated randomly, in a double-blind, placebo-controlled study, to receive one of three analgesic techniques (n = 10): lumbar extradural analgesia using 0.5% bupivacaine 1 mg kg-1 plus morphine 50 micrograms kg-1; morphine 100 micrograms kg-1 i.m.; or subpubic block using 0.5% bupivacaine 0.5 mg kg-1 for each side. ⋯ Children given extradural analgesia had more stable haemodynamic variables and smaller catecholamine concentrations and needed less anaesthetic supplementation, with no analgesic requirement in the postoperative period. Nausea or vomiting were not reported in children given subpubic block.
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We studied radiographically 11 patients in whom direct laryngoscopy proved difficult and 100 control (general population) subjects. The vertical distance between the mandible and the hyoid bone (mandibulohyoid distance) was measured and the positions of the mandibular angle and hyoid bone determined in relation to the cervical vertebrae. We found that the mandibulohyoid distance was substantially longer in patients whose trachea was difficult to intubate; the mandibular angle tended to be positioned more rostrally in both men and women, and the hyoid bone tended to be positioned more caudally in women. This suggests that a relatively short mandibular ramus or a relatively caudal larynx may be important, unfavourable anatomic factors in difficult laryngoscopy.