ABSTRACT
Background: several factors influence the decision of the anesthesiologist on the optimal choice of appropriate neuromuscular blocking agent [NMBa]. The aim of this study was to compare equi-lasting doses of a short-acting [mivacurium] to an intermediate- acting [rocuronium] neuromuscular relaxants, with regard to intubating conditions, efficacy, number of maintenance doses, hemodynamic resporses, and adverse events, in patients undergoing laparoscopic gynecological surgery
Methods: Sixty patients were randomly allocated to receive either 0.2mg/kg mivacurium or 0.5mg/kg rocuronium, under propofol/fentanyl anesthesia. T1, first twitch of the train-of-four [TOF] and TOF ratio [T4:T1] were used to evaluate the neuromuscular block using accelerometry [TOF Guard, Organon, Teknika]. The trachea was intubated when T1 was maximally suppressed. Neuromuscular block was maintained at 25% T1 with equi-lasting closes of 0.07mg/kg mivacurium or 0.1 mg/kg rocuronium
Results: Mean [min]+/-SD mivacurim onset time [1.8+/-0.3] was longer than that of rocuronium [1.25 +/- 0.4]. This did not yield a statistical difference in into- bating conditions between the two groups. Interval 25.75% T1 recovery and time to 0.8 TOF recovery were prolonged following rocuronium [12.1 +/- 4.8, 5 1.9+/- 13.5 respectively] compared to mivacurium [7.1. + 3 2 38.8 +/-7.9 respectively]. More patients 23/30 required mivacurium maintenance close compared to 14/30 patients in rocuronium group. Arterial blood pressure declined and 10 patients manifested erythema following mivacurium administration. Five patients developed PONV in mivacurium group compared to one patient in rocuronium
Conclusion: Equi lasting doses of rocuronium resulted in favourable intubating conditions more rapidly, improved hemodynamic stability, required less frequent administration of maintenance doses and were not associated with crythema, compared to mivacurium
ABSTRACT
Background: Combined spinal epidural [CSE] analgesia, is wildly used to provide pain relief in labour. It provides rapid reliable analgesia with minimal motor blockade. In randomized, double blind study, we compared ropivacaine versus bupivacaine both with fentanyl during labour using CSE technique
Methods: Forty patients were allocated randomly to receive either 2.5 mg ropivacaine in group I or 2.5 mg bupivacaine in group 2 intrathecally, both with fentanyl 25 microg. Epidural top-up were given from premixed solution of 0.125% ropivacaine with 2 jig/mi fentanyi in group I or 0.125% bupivacaine with 2 microg/ ml fentanyl in group 2. Onset, duration of analgesia, level of sensory block, motor power in lower limbs, VAS scores, side effects as well as neonatal Apgar scores were evaluated
Results: There were no significant differences between the two groups regarding the onset, duration, level of sensory block an VAS scones during the study.25% of women [5/20] in bupivacaine group developed detectable motor blockade compared to 5% [1/20] in ropivacaine group. Adverse effects did not differ between the two groups, neontal outcome was similar in both groups
Conclusion: Using combined spinal epidural technique, ropivacaine with fentanyl provides rapid, safe, reliable analgesia for labour as effective as that achieved by bupivacaine with fentanyl. Motor blockade with significantly low with ropivacaine compared to bupivacaine