ABSTRACT
Mivacurium is a relatively new short-acting nondepolarizing neuromuscular blocker. A recommended dose of 0.15-0.2 mg kg-1 provides tracheal intubating conditions within 2.5 min and duration of action of 15-30 min, making it a possible alternative to suxamethonium for short procedures requiring tracheal intubation. However, in common with suxamethonium its metabolism depends primarily on plasma cholinesterase and its duration of action is prolonged in patients with reduced plasma cholinesterase activity. We present a case of unexpected prolonged neuromuscular block in a child with previously undiagnosed plasma cholinesterase deficiency.
Subject(s)
Cholinesterases/deficiency , Isoquinolines/metabolism , Nerve Block , Neuromuscular Junction/drug effects , Neuromuscular Nondepolarizing Agents/metabolism , Anesthesia Recovery Period , Child , Genotype , Humans , Male , Mivacurium , Time FactorsABSTRACT
This study compares the anaesthetic effects of intrathecal pethidine or bupivacaine in patients undergoing surgery for transurethral resection of the prostate. Patients were randomly allocated to receive 3.5 ml of 0.5% plain bupivacaine or 1 mg kg-1 of 5% pethidine. The onset, extent and duration of sensory and motor blockade were studied. The cardiovascular and respiratory variables and frequency of side-effects were noted, both in the intra-operative period and the first 24 h of the post-operative period. There were no significant differences in intra-operative conditions or post-operative complications. The duration of block was significantly shorter with pethidine but was not associated with a difference in post-operative pain or analgesic requirements; this may have advantages when early post-operative mobility is indicated. We conclude that spinal pethidine is a satisfactory agent for transurethral resection of the prostate.
Subject(s)
Anesthesia, Spinal , Bupivacaine , Meperidine , Prostatectomy , Aged , Humans , MaleABSTRACT
Triazolam 0.25 mg, diazepam 10 mg and placebo were compared in a randomized double-blind trial of oral premedication in 90 patients undergoing minor gynaecological surgery. Both triazolam and diazepam produced a significant sedative effect as measured by patient self assessment linear analogue scales but only diazepam was more anxiolytic than placebo. Psychomotor performance assessed by the letter-search test at 3 and 6 hours after awakening showed a decrement in performance in patients receiving triazolam at 3 hours compared with the two other groups. Triazolam was shown to have a pronounced amnesic effect and whilst it might be used for premedication, its lack of anxiolysis coupled with a significant impairment of psychomotor performance at 3 hours after awakening, render the drug unsuitable for premedication in the short stay patient.
Subject(s)
Anti-Anxiety Agents/therapeutic use , Diazepam/therapeutic use , Preanesthetic Medication , Triazolam/therapeutic use , Adult , Anxiety , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Middle Aged , Pregnancy , Psychomotor Performance/drug effectsABSTRACT
The effects of pancuronium and vecuronium on the lower oesophageal sphincter pressure were studied in 24 healthy patients anaesthetised with 0.5% halothane in nitrous oxide and oxygen. Following pancuronium 0.1 mg/kg intravenously, there was a significant increase in barrier pressure from a control value of 2.0 (SEM 0.14) kPa to 3.0 (SEM 0.27) kPa 1 minute after injection (p less than 0.05). This increase was sustained throughout the 15 minute period of recording and was accompanied by a significant increase in heart rate (p less than 0.001). Following administration of vecuronium 0.1 mg/kg intravenously there was an initial modest, though not significant increase in barrier pressure. This increase was significant (p less than 0.05) at 15 minutes. There were no cardiovascular changes following vecuronium.
Subject(s)
Esophagogastric Junction/drug effects , Neuromuscular Blocking Agents/pharmacology , Pancuronium/analogs & derivatives , Pancuronium/pharmacology , Anesthesia, Inhalation , Blood Pressure/drug effects , Female , Halothane , Heart Rate/drug effects , Humans , Nitrous Oxide , Pressure , Random Allocation , Stomach/physiology , Vecuronium BromideABSTRACT
The effects of pancuronium and atracurium on the lower esophageal sphincter pressure (LESP) were studied in 24 healthy patients anesthetized with 0.5% halothane in 66% nitrous oxide in oxygen. After pancuronium (0.1 mg X kg-1) given intravenously there was a significant increase in LESP from a control value of 36 +/- 4.0 cm H2O to 50 +/- 4.6 cm H2O at 1 min. This produced an increase in barrier pressure (BRP) from 26 +/- 3.7 cm H2O to 41 +/- 4.3 cm H2O. These changes were sustained for 5 min accompanied by a significant increase in arterial pressure and heart rate. Atracurium (0.6 mg X kg-1) had no cardiovascular effects and produced little changes in either LESP or BRP. The findings of this study suggest that pancuronium may be of benefit in a rapid sequence induction.
