British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Neurobehavioural effects of propofol on the neonate following elective caesarean section.
Forty mothers undergoing elective Caesarean section under general anaesthesia were allocated randomly to receive either propofol 2.8 mg kg-1 (n = 20) or thiopentone 5 mg kg-1 (n = 20) for induction of anaesthesia. Twenty neonates delivered by uncomplicated vaginal delivery were evaluated also as unmedicated controls. Neurobehavioural examinations were carried out at 1, 4 and 24 h after delivery. ⋯ Newborn children examined 1 h after birth, after maternal anaesthesia with propofol, showed a depression in alert state, pinprick and placing reflexes, and mean decremental count in Moro and light. There was a generalized irritability in 25% of them. This depression was not observed at 4 h.
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Randomized Controlled Trial Clinical Trial
Accelerated recovery from combined atracurium-vecuronium neuromuscular block.
Patients given combinations of non-depolarizing neuromuscular blocking drugs have been reported to recover from neuromuscular block more rapidly than patients given a single drug. This study was designed to assess if this phenomenon occurred with the combination of atracurium and vecuronium. ⋯ All patients had 100% neuromuscular block, and times to block onset did not differ significantly between the three groups. Recovery to 10, 25, 50 and 90% of control twitch height was significantly faster in the group receiving the combination of drugs.
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Twenty-nine patients (age range 14-81 yr) undergoing orthopaedic surgery received alfentanil 100 micrograms kg-1 given as two i.v. boluses followed by a fixed rate infusion of 1 micrograms kg-1 min-1 for 44-445 min. Additional 1-mg bolus doses of alfentanil were administered as required. Plasma samples were assayed for alfentanil using radioimmunoassay. ⋯ For patients older than 40 yr, T 1/2 beta increased linearly with age. There was no significant decrease in Cl with age, although the lower values for Cl (100-200 ml min-1) were generally found in subjects older than 60 yr. The present study demonstrated that a 100-micrograms kg-1 loading dose and a 1-micrograms kg-1 min-1 infusion may be appropriate for analgesia in general surgical procedures.
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Anaesthetic techniques for malignant hyperthermia susceptible (MHS) patients should include drugs which do not trigger MH and provide stress free conditions. Thus all new drugs should be screened for their susceptibility to trigger MH. ⋯ However, the same animals developed MH when exposed to halothane alone or with suxamethonium. Despite the problems of extrapolating from this study to man, it is unlikely that propofol may trigger an episode of MH.