British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Pretreatment with vecuronium as a prophylactic against post-suxamethonium muscle pain. Comparison with other non-depolarizing neuromuscular blocking drugs.
One hundred and ninety-eight patients undergoing minor surgery were assessed for evidence of post-suxamethonium muscle pain on the 1st and 2nd days following surgery. Patients were allocated to nine groups and were given one of four non-depolarizing neuromuscular blocking drugs (vecuronium, gallamine, tubocurarine or pancuronium) 1 or 2 min before the administration of suxamethonium. A control group received an inert medication. ⋯ This frequency was decreased to around 20% following pretreatment. In general, the frequency of pain was less in the groups receiving pretreatment at 1 min, but the difference was not significant. The groups receiving vecuronium before suxamethonium had the lowest overall frequency of pain over the 2 days (19%), although this was not significantly different from other pretreatments.
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The neuromuscular and cardiac vagus blocking actions of pancuronium, vecuronium (Org NC45) and their respective potential hydroxy metabolites have been studied in the chloralose-anaesthetized cat. Pancuronium was three times more potent as a neuromuscular blocker than its 3-hydroxy derivative, 20 times more potent than the 17-hydroxy derivative and 45 times more potent than the 3,17-dihydroxy derivative. The vagal:neuromuscular block ratios measured at 50% inhibition for these compounds were pancuronium 3.0, 3-hydroxy derivative 6.4, 17-hydroxy derivative 1.1 and 3,17-dihydroxy derivative 0.36 (a value greater than unity indicated greater potency at the neuromuscular junction). ⋯ In addition, the time-course of its action was not different from that of vecuronium. Thus, it is concluded that this potential metabolite is unlikely to give rise to tachycardia in man. It is unlikely that the 17-hydroxy and 3,17-dihydroxy derivatives of vecuronium would be produced in sufficiently great quantities by metabolism from vecuronium to result in either tachycardia or residual neuromuscular blockade.
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Inaccuracy of oesophageal pressure for pleural pressure estimation in supine anaesthetized subjects.
Oesophageal pressure was measured, using a balloon and catheter system, at three or four positions in the oesophagus of eight supine subjects anaesthetized with 1-1.5% halothane in 67% nitrous oxide. Airway pressure and the difference between airway and oesophageal pressures were recorded during occlusion of inspiration, occlusion of expiration and occlusion of expiration followed by inspiratory occlusion. ⋯ The change in oesophageal pressure was expressed as a fraction of the change in airway pressure: the maximum fraction was obtained in each patient, and the mean of these maximum values was 82%. This suggests that changes in the difference between airway and oesophageal pressures will overestimate the change in transpulmonary pressure during artificial ventilation in supine subjects, and that lung compliance would be underestimated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neuromuscular blocking effects of vecuronium and pancuronium during halothane anaesthesia.
The neuromuscular blocking properties of vecuronium (Org NC 45) and pancuronium were compared in 40 patients during halothane anaesthesia. Onset time was found to be dose-dependent, but no significant difference was found between the two drugs. ⋯ Recovery indices following both doses of vecuronium (10.0 min and 11.8 min) were significantly shorter than after pancuronium (31.0 min and 46.9 min). The reversal times of vecuronium (times from 10% to 90% twitch height recovery) were significantly shorter than those of pancuronium (7.9 min and 7.3 min, respectively, compared with 17.1 min and 17.7 min).
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Comparative Study
Simultaneous variations of PaCO2 and PACO2 in assisted ventilation.
Thirty-two patients receiving artificial ventilation of the lungs were studied to determine if variations in PACO2 could be reflected in variation in PaCO2. Eleven patients had chronic obstructive lung disease, eight had suffered acute respiratory failure, and 13 had neurological disturbances but normal lungs. ⋯ Change in PaCO2 induced by ventilatory change and by change in inspired carbon dioxide concentration were well described by linear regression of PaCO2 on PaCO2. In patients with chronic lung disease, (PaCO2-PACO2) was the same at all values of PACO2 whereas, in the other patients the ratio PaCO2/PACO2 did not change.