British journal of anaesthesia
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Comparative Study
Evaluation of cumulative properties of three new nondepolarizing neuromuscular blocking drugs BW A444U, atracurium and vecuronium.
Comparative patterns of recovery during successive doses of three new, relatively non-cumulative, intermediate-duration non-depolarizing neuromuscular blocking drugs, BW A444U, atracurium (BW33A) and vecuronium (Org NC 45), were studied in 94 surgical patients during thiopentone in nitrous oxide and oxygen with narcotic anaesthesia. The train-of-four (TOF) pattern of nerve stimulation was used. The spontaneous 5-25% recovery time of the first twitch of TOF showed a statistically significant difference between the initial dose and the fifth incremental dose in the cases of atracurium and vecuronium, but not in the case of BW A444U. ⋯ The difference was significant only when the final dose of vecuronium was compared with the initial dose (TOF ratio 79.3 +/- 2.3% v. 64.3 +/- 4.4%; P less than 0.005). Analysis of variance indicates that the TOF ratio at 95% recovery of the first twitch of TOF after the final dose of vecuronium (64.3%) is significantly smaller (P less than 0.001) than that of either BW A444U (78%) or atracurium (84%), indicating that vecuronium appears to show more residual fade and greater cumulative effect after incremental doses than BW A444U or atracurium. The data suggest that the cumulative properties of the new drugs may be ranked as follows: atracurium less than BW A444U less than vecuronium.
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The effects of halothane and of prior administration of suxamethonium on atracurium neuromuscular blockade have been investigated. Halothane potentiated the intensity of block produced by atracurium 0.1 or 0.15 mg kg-1. Duration of block was prolonged (27%) by halothane with a small dose of atracurium (0.15 mg kg-1) and was also prolonged (29%) with larger doses of atracurium (0.4 mg kg-1). Prior suxamethonium 1 mg kg-1 increased the intensity of block after atracurium 0.15 mg kg-1 from 52% (control) to 84%, but caused minimal change in duration of atracurium blockade.
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Randomized Controlled Trial Clinical Trial
Intranasal administration of nitroglycerine attenuates the pressor response to laryngoscopy and intubation of the trachea.
The intranasal administration of nitroglycerine (NTG) was undertaken in 35 adult female patients 1 min before the induction of anaesthesia. A control group consisting of 32 patients did not receive NTG. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before the induction of anaesthesia and at 0, 3, and 5 min after tracheal intubation. ⋯ SAP did increase significantly in the control group. HR was increased in both groups immediately after intubation (P less than 0.001 and P less than 0.001 respectively). NTG administered intranasally is a safe, simple and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.