Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Feb 1992
Case ReportsMyasthenia gravis and pipecuronium--report of two cases.
The use of pipecuronium in two patients with myasthenia gravis undergoing thymectomy is described. Neuromuscular function was monitored throughout using the train-of-four (TOF) mechanical twitch response. The cumulative dose-response to pipecuronium was determined in both patients during nitrous oxide-oxygen-narcotic anaesthesia. ⋯ The ED50 doses of pipecuronium were 11.6 and 11.1 micrograms.kg-1 and the ED95 doses were 35 and 33.3 micrograms.kg-1 in patients #1 and 2 respectively. Edrophonium 1 mg.kg-1 and neostigmine 0.06 mg.kg-1 were administered to patients #1 and 2 respectively for antagonism of residual neuromuscular blockade at 25 per cent spontaneous recovery of first twitch (T1) of the TOF stimulation. As with other non-depolarizing muscle relaxants pipecuronium in reduced dosage and with careful neuromuscular monitoring can be used to provide surgical relaxation safely in patients with controlled myasthenia gravis.
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Middle East J Anaesthesiol · Oct 1991
Randomized Controlled Trial Clinical TrialSpinal and interpleural bupivacaine for percutaneous nephrolithotomy.
The promising interpleural block (IPB) technique stimulated the comparison of its adjuvant effect to spinal analgesia for percutaneous nephrolithotomy (PCNL) with that of meperidine-diazepam. Twenty five patients receiving spinal analgesia 15 mg 0.5% heavy bupivacaine for PCNL were randomly allocated to receive the adjuvant effect of either meperidine 1 mg/kg IV and diazepam 10 mg total dose (n = 10) or IPB with 10 ml 0.5% plain bupivacaine (n = 15). It was found that IPB produced a totally pain free operation and needed less frequent administration in the postoperative period, while meperidine-diazepam produced a pain free in 20% of patients and needed more frequent postoperative meperidine (1 mg/kg IM) administration.
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Middle East J Anaesthesiol · Feb 1991
Randomized Controlled Trial Comparative Study Clinical TrialThe hemodynamic effects of intravenous norepinephrine versus epinephrine and phenylephrine in patients with ischemic heart disease.
The hemodynamic effects of an intravenous bolus of norepinephrine 10 micrograms, phenylephrine 100 micrograms and epinephrine 10 micrograms were investigated in 30 patients scheduled for coronary artery bypass grafting. The hemodynamic changes following norepinephrine were similar to those achieved by phenylephrine. ⋯ In contrast, epinephrine increased the mean arterial pressure and cardiac output without a significant change of systemic vascular resistance. The results suggest that intravenous norepinephrine acts similar to phenylephrine as an alpha-adrenergic agonist, while epinephrine acts predominantly as a beta-adrenergic agonist.
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Middle East J Anaesthesiol · Feb 1991
Randomized Controlled Trial Comparative Study Clinical TrialTracheal soiling with blood during intranasal surgery--comparison of two endotracheal tubes.
Sixty adult patients, ASA Classes I & II, were involved in a study to compare the effectiveness of Mallinckrodt Hi-Lo-Evac tube and Portex blue line tube in preventing soiling of the lower airways during intranasal surgery. The Hi-Lo-Evac tube with and without pack was significantly more effective than the Portex tube with pharyngeal pack (P less than 0.002) and (P less than 0.01 respectively). ⋯ The more effective protection of the lower airways by the Hi-Lo-Evac tube is attributed to the facility of subglottic aspiration during surgery. It is suggested that the Hi-Lo-Evac tube could be used with safety during intranasal surgery in order to reduce postoperative morbidity associated with the use of pharyngeal pack.