Articles: intubation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre Trial.
A multicentre trial was designed to determine the dose-response and side-effects of esmolol when administered as a single iv bolus prior to induction of anaesthesia for controlling the haemodynamic response to tracheal intubation. Five hundred and forty-eight patients from 12 university-affiliated centres across Canada were randomized prospectively to receive either placebo (PLAC) or esmolol (E) in a dose of 100 mg (E100) or 200 mg (E200). Study medication was given immediately before induction of anaesthesia with thiopentone 3-5 mg.kg-1 and succinylcholine 1.5 mg.kg-1. ⋯ Other side-effects, such as bradycardia, bronchospasm or pain on injection, occurred no more frequently in either esmolol group than with placebo. It is concluded that a 100 mg bolus of esmolol is safe and effective for controlling the haemodynamic response to tracheal intubation. This dose of esmolol combined with a low dose of narcotic (fentanyl 2-3 micrograms.kg-1 or equivalent) results in effective control of both heart rate and blood pressure, while avoiding important side-effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of high and low doses of suxamethonium.
In a double-blind study, 67 young adult patients undergoing anaesthesia for dental extractions were allocated at random to receive either 0.5 mg/kg or 1.5 mg/kg suxamethonium. A greater increase in arterial pressure was seen following induction in the 1.5 mg/kg group, although overall intubating conditions were similar in the two groups. Suxamethonium-associated muscle pains were significantly more common in the group which received the larger dose (p less than 0.05).
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Comparative Study
Effectiveness of preoxygenation in morbidly obese patients.
The time taken for the oxygen saturation (SpO2) to decrease to 90% after preoxygenation was studied in six morbidly obese patients and six matched controls of normal weight. During apnoea the obese patients maintained Spo2 greater than 90% for 196 (SD 80) s (range 55-208 s), compared with 595 (SD 142) s (range 430-825 s) in the control group (P less than 0.001). One patient in the obese group had desaturation before the onset of complete relaxation and tracheal intubation, without complications. Bedside lung function tests were not significantly different between groups and cannot be used as a predictor of the effectiveness of preoxygenation.