British journal of anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
Clinical observations on the neuromuscular blocking action of Org 9426, a new steroidal non-depolarizing agent.
The neuromuscular blocking effects of Org 9426, the 2-morpholino, 16-allyl-pyrrolidino derivative of the 3-desacetoxy analogue of vecuronium have been investigated in anaesthetized patients. Based on data from a pilot study, two doses, 250 and 500 micrograms kg-1 (estimated as the ED90 and 2 x ED90, respectively) were chosen. ⋯ Side effects were not noted. Org 9426 may have advantages over existing non-depolarizing neuromuscular blocking agents with respect to rate of development of good intubating conditions, and is stable in aqueous solutions.
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Randomized Controlled Trial Clinical Trial
Influence of fluid regimens on perioperative blood-glucose concentrations in neonates.
Blood concentrations of glucose were measured during surgery and during the first 8 h after operation in 30 neonates undergoing major surgery during the first week of life. Fifteen of the neonates were given Ringer-acetate as the only crystalloid peroperative fluid; to the other 15, 10% glucose i.v. was administered during surgery. In the Ringer-acetate group, mean (SD) blood concentration of glucose increased from 3.1 (2.0) to 4.3 (2.4) mmol litre-1 during surgery. ⋯ Hypoglycaemia occurred in both groups, but more often in the group given Ringer-acetate only (3/15 vs 1/15). Hypoglycaemia was found only in neonates less than 48 h of age and during the first 1 h of anaesthesia only. Monitoring of blood concentrations of glucose and adjustment of the glucose infusion appears to be desirable during and after surgery in neonates.
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Two patients suffered barotrauma whilst undergoing transtracheal jet ventilation (TTJV). In the first, TTJV was provided by a Sanders injector and in the second it was given by a high frequency jet ventilator. ⋯ The mechanism of barotrauma and a method of airway pressure monitoring during TTJV are discussed. It is recommended that meticulous care is taken to ensure an adequate path for expiration when jet ventilation is used.
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The anaesthetic records of 61 patients who had experienced adverse reactions thought to be malignant hyperthermia (MH) were reviewed retrospectively to evaluate the diagnostic importance of clinical symptoms. Using the in vitro contracture test, 38 (62%) patients were identified as MH susceptible (MHS), the remainder showing normal test results (MHN). Generalized rigidity, ventricular arrhythmias, cyanosis and postoperative myoglobinuria were observed significantly more often in MHS patients. ⋯ Masseter spasm and sinus tachycardia were as common in MHS as in MHN individuals. Statistical models using generalized rigidity, ventricular arrhythmias, cyanosis and fever exceeding 38 degrees C for prediction of MH showed a maximum sensitivity and specificity of 78% and thus are not acceptable for clinical use. For definitive diagnosis of MH, the well established in vitro contracture test remains essential.
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To determine if functional residual capacity (FRC), compliance of the respiratory system (C), or underlying pulmonary disease are predictive for the efficacy of high frequency jet ventilation (HFJV) on pulmonary gas exchange, we investigated six adult patients within 4 h of abdominal surgery and six patients with severe adult respiratory distress syndrome. Gas exchange during intermittent positive pressure ventilation (IPPV) was compared with that during HFJV at frequencies of 100 b.p.m. (HFJV100) and 200 b.p.m. (HFJV200), resulting in a minute ventilation of about 400 ml kg-1 with both ventilatory frequencies, and in both groups of patients. Baseline FRC and C were measured during IPPV with the multiple-breath nitrogen washout method and from expiratory pressure-volume curves, respectively. ⋯ Similarly, changes in arterial partial pressure of carbon dioxide (PaCO2) induced by HFJV correlated negatively with C (HFJV100: r = -0.77, P less than 0.001; HFJV200: r = -0.61, P less than 0.05). In contrast, there was no significant correlation between FRC measured during IPPV and changes in (PAO2 - PaO2): FIO2 ratio or PaCO2 induced by HFJV, as these changes were influenced more by the patient's pulmonary disease than by baseline FRC. These results should be interpreted in the context of different underlying pathophysiological mechanisms reducing FRC in both groups of patients.