Articles: anesthetics.
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J Cardiothorac Anesth · Apr 1988
Clinical TrialA method of rapid-sequence induction using high-dose narcotics with vecuronium or vecuronium and pancuronium in patients with coronary artery disease.
A method of rapid-sequence induction was studied in 18 patients undergoing coronary artery bypass grafting (CABG) to assess the adequacy of relaxation for endotracheal intubation without resulting in major changes in heart rate (HR). Ten patients received vercuronium, 0.2 mg/kg (V); and eight patients received vecuronium, 0.1 mg/kg, and pancuronium, 0.1 mg/kg (V + P). All patients then received fentanyl, 50 to 70 microg/kg, or sufentanil, 5 to 7 microg/kg, followed 60 seconds later by intubation. ⋯ All patients were intubated without difficulty. The mean change in HR was -4.1 beats/min for patients receiving V and +16.4 beats/min for those receiving V + P (P < .002 for change in HR), with two V + P patients developing tachycardia. It is concluded that the onset of neuromuscular blockade is more rapid in the distribution of the mandibular nerve than at the ulnar nerve; mandibular nerve stimulation is a better predictor of adequate intubating conditions; good intubating conditions can be attained with either V or V + P; and, rapid-sequence induction with V is safe from a cardiac standpoint as measured by changes in HR, but the addition of pancuronium is unnecessary.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between propofol and ketamine for anaesthesia in the elderly. Haemodynamic effects during induction and maintenance.
The haemodynamic effects of propofol and ketamine were studied in two groups of eight randomly allocated elderly patients (mean age 85.8 years) anaesthetised for hip replacement. Group 1 patients patients received propofol 1 mg/kg by intravenous bolus for induction and 0.1 mg/kg/minute by continuous infusion for maintenance. Group 2 patients received ketamine 1.5 mg/kg by intravenous bolus as induction dose and 50 micrograms/kg/minute by continuous infusion for maintenance. ⋯ Myocardial oxygen consumption showed a significant decrease of 27%. There was a significant increase in blood pressure and pulmonary capillary wedge pressure (by 97%) in group 2. Cardiac output and systemic vascular resistance remained unchanged whereas myocardial oxygen consumption showed a very significant increase of 100%.
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Randomized Controlled Trial Clinical Trial
Pain-free injection in infants. Use of a lignocaine-prilocaine cream to prevent pain at intravenous induction of general anaesthesia in 1-5-year-old children.
A randomised, placebo-controlled, double-blind study was undertaken in 111 children between the ages of 1 and 5 years to assess the efficacy of EMLA 5% cream in the alleviation of venepuncture pain at intravenous induction of general anaesthesia using 27-gauge needles. Pain assessment was made by an operating department assistant using both verbal rating scale and visual analogue scale methods. ⋯ Significantly lower pain scores were recorded in the children treated with EMLA cream (verbal rating scale: premedicated p less than 0.05, unpremedicated p less than 0.001; visual analogue scale: premedicated p less than 0.0005, unpremedicated p less than 0.0002). No variation in analgesia was found for application times between 30 and 300 minutes and there were no serious side effects.
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Twenty patients, ASA grades 1 and 2, aged 18-65 years were admitted to an open study to investigate the ease of tracheal intubation after induction of anaesthesia with propofol without the use of muscle relaxants after the chance observation that propofol 2.5 mg/kg allowed easy laryngoscopy and tracheal intubation. Satisfactory intubation conditions were achieved in 19 patients.