British journal of anaesthesia
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Comparative Study
Comparison of vecuronium, atracurium and tubocurarine in normal patients and in patients with no renal function.
Vecuronium (initial dose 0.1 mg kg-1; incremental doses 0.04 mg kg-1) was given to 21 normal and 21 anephric patients. There were no gross differences between the two groups in the effect or in the duration of action of either initial or incremental doses, except in two anephric patients who were resistant to the agent. Reversal with neostigmine was satisfactory. ⋯ However, in anephric patients, except in the resistant patients, the behaviour of vecuronium was similar to that of atracurium (26 patients). A comparison with an initial dose of tubocurarine 0.5 mg kg-1 given to 20 anephric patients and tubocurarine 0.6 mg kg-1 given to 21 normal and 20 anephric patients showed tubocurarine to be longer acting and considerably less predictable. This was particularly so in the anephric group, in which its action sometimes persisted after neostigmine had been given.
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India ink was injected through extradural catheters placed in the posterior intercostal space in 12 cadavers undergoing autopsy and the subsequent spread of the India ink was assessed under direct vision. The ink spread subpleurally to reach a number of intercostal spaces and medially to reach the paravertebral space. It is concluded that analgesia extending over a number of dermatomes is achieved by subpleural tracking of local anaesthetic to reach intercostal nerves above and below the one injected.