British journal of anaesthesia
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Comparative Study
Emergency intubation of the trachea facilitated by suxamethonium. Observations in obstetric and general surgical patients.
The relationship between the time of onset of neuromuscular blockade and the time at which laryngoscopy was attempted was studied in patients presenting for emergency obstetric or emergency general surgical procedures. "Train-of-four" stimulation and visual observation of the evoked twitch response in the hand were used as a measure of the degree of neuromuscular blockade. The attendant anaesthetist was unaware of the response to the peripheral nerve stimulator. Intubation preceded complete neuromuscular blockade; in the obstetric patients there was no correlation between the two times. The use of a peripheral nerve stimulator should allow the anaesthetist to perform intubation in emergency situations with a greater degree of safety.
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Comparative Study
Recovery of spontaneous breathing following neuromuscular blockade with atracurium.
Atracurium 0.3 mg kg-1 was given to two groups of patients to compare the recovery of spontaneous breathing with that of peripheral neuromuscular function. Anaesthesia was maintained in one group (n = 6) with an infusion of etomidate (mean flow rate 24 micrograms kg-1 min-1) and in the other group (n = 5) with 0.5% halothane. ⋯ Adequate recovery of respiratory muscle function occurred within 30 min of administration of atracurium at a time when there was less than 25% recovery of the tetanic response of the adductor pollicis muscle. It was concluded that recovery of the muscles of respiration from neuromuscular blockade by atracurium occurred more rapidly than recovery of the muscles of the hand, but an adequate tidal volume in the absence of other clinical signs should not be regarded as a reliable indicator of complete return of neuromuscular function.
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Randomized Controlled Trial Clinical Trial
Regional analgesia with bupivacaine in dental anaesthesia.
Sixty (ASA 1) patients were studied to determine the effect of bilateral local infiltration with 0.25% bupivacaine plain during third molar extraction under general anaesthesia. Bupivacaine infiltration significantly reduced the incidence of wide complex extrasystoles (P less than 0.05) during surgery and the severity of dental pain (P less than 0.05), when assessed at 6 h after operation.
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Pure suxamethonium chloride does not produce in vitro contracture of skeletal muscle from swine which are susceptible to malignant hyperpyrexia (MH), but does induce MH in vivo. It is suggested that suxamethonium chloride induces MH because the fasciculations which it causes lead to an increase in the myoplasmic calcium concentration.