British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison between the continuous infusion of vecuronium and the intermittent administration of pancuronium and vecuronium.
The neuromuscular blocking effects of repeated bolus injections of pancuronium, or vecuronium, and of the continuous infusion of vecuronium have been compared in 36 patients by means of evoked twitch tension. Groups I and II received a loading dose (0.075 mg kg-1) of pancuronium or vecuronium, respectively, followed by 0.015-mg kg-1 maintenance doses when twitch tension had recovered to 25% of control. Group III received a 0.075-mg kg-1 loading dose of vecuronium plus a continuous infusion (commenced simultaneously) delivering 0.075 mg kg-1 h-1. ⋯ These values did not correlate with the total dose of vecuronium infused. For clinical practice, the suggested loading dose is 1.5 times the ED90 (= 0.07 mg kg-1) followed by an infusion of the same dose per hour. The infusion should be started within 10 min of the injection of the loading dose.
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Evidence of central nervous system toxicity was noted in two patients undergoing extradural analgesia for Caesarean section. There was no cardiovascular depression and both patients recovered rapidly. The patients had received total doses of bupivacaine plain solution of 357.5 mg and 356.25 mg, respectively and the relationship of these to the clinical signs of bupivacaine toxicity is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of naloxone on the loss of consciousness induced by i.v. anaesthetic agents in man.
The effect of a specific opioid antagonist, naloxone, was studied in two comparable groups of patients who received i.v. the dose of an anaesthetic agent required to produce loss of consciousness in 50% of subjects. The first group received naloxone 0.006 mg kg-1 5 min before induction of anaesthesia; the second group received a similar volume of saline solution. ⋯ The differences in percentage of unconscious patients between the naloxone-treated group and the control group were statistically significant for diazepam, ketamine and propanidid. Naloxone did not modify the induction of anaesthesia with thiopentone or Althesin.
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The venous plasma concentration-time profiles of thiopentone were measured simultaneously over the first 30-40 min after induction of anaesthesia, in blood obtained from an arm vein and a vein in the foot, in nine healthy full-term women undergoing Caesarean section. Patients were tilted laterally to the left by from 8 to 18 degrees during the procedure. In all but two of the patients, the profiles from the arm and foot were virtually identical, suggesting that aortocaval compression was absent or insignificant. Therefore, the large intersubject variability in volume of distribution of thiopentone at Caesarean section is unlikely to be the result of aortocaval compression.
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Seventy-five patients requesting extradural analgesia for the relief of pain in labour underwent an ultrasound scan to measure the depth to the extradural space. There was a high degree of correlation between these measurements and the subsequent depth of insertion of the Tuohy needle. The advantages of the technique in clinical practice and as an aid to teaching, are discussed.