British journal of anaesthesia
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An inhibition assay was used to determine quantitatively the allergenic cross-reactivity of some myoneural blocking drugs not yet released for use in Australia, in the sera of patients who had experienced anaphylactic reactions to neuromuscular blocking drugs. Two of the compounds, metocurine and atracurium were highly cross-reactive with the currently used myoneural blockers; fazadinium was weakly cross-reactive and vecuronium intermediate in potency between these two extremes. From these results, we predict that anaphylactic reactions to these compounds, and particularly to metocurine and atracurium, will occur in some patients allergic to the currently used neuromuscular blocking agents.
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The case of a pregnant patient with diffuse scleroderma who died following Caesarean section under general anaesthesia is presented. The patient's postoperative course was complicated by pulmonary oedema and pulmonary hypertension, sepsis, thrombocytopenia and renal failure. Aspects of the disease which possess anaesthetic implications are reviewed.
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The presentation and features of Duchenne's progressive muscular dystrophy (Duchenne's PMD) are described and the increased risks associated with anaesthesia are considered. Hazards associated with induction of anaesthesia and immediate postoperative recovery have been stressed in recent case reports, and these are summarized. Features of a hyperpyrexia-like response including cardiac arrest, increased serum creatine phosphokinase concentration, myoglobinuria and metabolic acidosis following suxamethonium or halothane, or both, have been described in patients with Duchenne's PMD. ⋯ In five of the children, cardiac arrest occurred despite apparently adequate respiratory support. Suxamethonium was common to the anaesthetic received by all six patients. In one of these patients subsequent anaesthetics, without suxamethonium, were uneventful and delayed muscle weakness did not occur.
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Comparative Study
Effect of meptazinol on neuromuscular transmission in the isolated rat phrenic nerve-diaphragm preparation.
Meptazinol has been shown to have significant effects on neuromuscular transmission in the isolated rat phrenic nerve-diaphragm preparation. The response of the preparation to indirect electrical stimulation was increased in a concentration-dependent manner by meptazinol hydrochloride 2-32 micrograms ml-1. ⋯ These effects were similar to those obtained with neostigmine and it was demonstrated that meptazinol had significant anti-cholinesterase activity in the concentrations used. Inhibition of cholinesterase with ecothiopate revealed a neuromuscular blocking activity of meptazinol in concentrations as low as 0.25 micrograms ml-1.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal anaesthesia with 0.75% bupivacaine and 0.5% amethocaine in 5% glucose.
Three millititre of 0.75% plain bupivacaine and 0.5% amethocaine 3 ml in 5% glucose were used for spinal anaesthesia and compared in a double-blind study of 20 patients undergoing urological surgery. The onset time to maximum cephalad spread of sensory analgesia was approximately 45 min for bupivacaine and approximately 30 min in the amethocaine group (ns). The mean maximum spread of sensory analgesia was similar for both agents: T6-7 180 min after injection, although the cephalad spread of sensory analgesia with bupivacaine persisted for longer at a significantly higher level than that of amethocaine. ⋯ Onset time to complete motor blockade of the lower limbs was similar for both agents. Nine of 10 bupivacaine patients and seven of the 10 patients receiving amethocaine had complete motor blockade of the lower limbs. Duration of motor blockade was significantly longer for all degrees in the bupivacaine group.