Post-tetanic count [PTC]: a new technique of evaluating profound neuromuscular block of different non-depolarizing muscle relaxants

Forty five adult patients scheduled for eye or ear surgery were studied to evaluate the PTC as a method to predict neuromuscular recovery. They were given either 0.08 mg kg[-1] pancronium, 0.1 mg kg[-1] vecuronium or 0.5 mg kg[-1] atracurium during thiopental-nitrous oxide-halothane anaesthesia. Ulnar nerve at the wrist was stimulated and the force of contraction of the adductor pollicis was recorded, we focused on the period of intense neuromuscular block [the period of no response] using the PTC method. This study showed that PTC method can give early warning about the onset of neuromuscular recovery offering the opportunity to give supplementary doses of muscle relaxant at the proper time. The first response to post tetanic twitch stimulations appeared on average 35.5, 9 and 11 min. before the first detectable response to TOF stimulation for patients given pancuronium. vecuronium and atracurium respectively. This study proved a close relationship between PTC and time interval between the PTC and the first detectable response to TOF nerve stimulation. We concluded that PTC method can effectively monitor part of the period of no response and can be used to predict the time to appearance of the first detectable response to TOF. It is a valuable supplement to TOF stimulation during clinical anaesthesia

Analgosedation for extracorporeal shock wave lithotripsy a retrospective study

This study included 2195 patients [male: female 1730:465] with kidney and ureteric stones; they were subjected to ESWL. The age range was 16-87 years and the physical status was ASA I, II, III. Patients were allocated into seven groups according to whether no drugs given or morphine, pethidine, fentanyl [alone or in combination with midazolam] were used for pain relief and sedation. Pain score was evaluated according to the 4-point verbal scale that ranged from 0 [no pain] to 3 [intolerable pain]. 55.48% of patients did not require any analgesia or sedation, while there was no statistically significant difference as regards the pain score among the other six groups receiving analgesia [+ sedation]. There was no statistically significant difference among different groups as regards changes of blood pressure or heart rate. The total incidence of dysrhythmia was 28.9%, most of these were self limited required no treatment of these, only 2.2% had frequent PVCs [> 5 pvcs/min.], where i.v. xylocaine was given and the lithotripter was shifted to ECG trigger mode. Nausea and vomiting were not reported, but hiccough [2.5 - 2.7%] occurred in patients receiving midazolam