Reversal of pipecuronium bromide with pyridostigmine.

Pipecuronium Bromide (Arduan, Organon, Inc, West Orange) is a long-acting, nondepolarizing neuromuscular blocking agent. The efficacy of pyridostigmine 170 micrograms/kg intravenously (approximately 10 mg/70 kg) for reversing pipecuronium has not been reported. This study was performed to determine the time required to obtain a train-of-four (TOF) ratio of 0.7 after administration of pyridostigmine 140 micrograms/kg at 25% recovery of T1 after pipecuronium-induced neuromuscular blockade. Sixteen, American Society of Anesthesiology (ASA) I or II patients undergoing surgical procedures of at least 90 minutes, requiring intubation and muscle relaxation were included. Neuromuscular blockade was assessed using the Puritan-Bennett/Datex NMT 221 placed for ulnar nerve stimulation. Anesthesia was maintained with a nitrous oxide/narcotic technique and the use of potent inhalational anesthetics was avoided. The mean reversal time was found to be 16.14 minutes, with a minimum of 10.3 minutes and a maximum of 24.3 minutes. The standard error was +/- 1.05 minutes with a variance of 17.68 minutes.

Intranasal administration of midazolam to a severely burned child.

This report describes the use of intranasally administered midazolam for sedation in a critically ill burned paediatric patient without venous access. Placement of a central venous catheter was successfully carried out following sedation by this method.

Changes in arterial oxygen saturation in cigarette smokers following general anaesthesia.

The effect of cigarette smoking on postoperative arterial oxygen saturation was evaluated in 45 adult patients using pulse oximetry. Patients were divided into a smoking group (n = 20) and a non-smoking group (n = 25) based on current smoking habits up until the time of surgery. The two groups were similar with respect to sex, ASA physical status, surgical procedure, duration of anaesthesia, narcotic and anaesthetic use and recovery characteristics. The non-smoking group was, however, significantly (P less than 0.05) older than the smoking group. Postoperative oxygen saturation (SaO2) decreased (P less than 0.001) during transport of both groups of patients from the Operating Room to the Recovery Room; a decrease which was significantly greater in the smoking group. The severity of hypoxaemia was also significantly greater in the smoking group than in the non-smoking group. This study suggests that cigarette smoking contributes to postoperative arterial oxygen desaturation following general anaesthesia and that supplemental oxygen should be administered to these patients during postoperative transport.

The cost-effectiveness of Oximetrix pulmonary artery catheters in the postoperative care of coronary artery bypass graft patients.

As cost-containment pressures continue to escalate in the health care industry, the cost-effectiveness of new technologies must be verified if their use in the care of patients is to be justified. Oximetrix fiberoptic pulmonary artery catheters (Abbott Critical Care Systems, North Chicago, IL) are used for the continuous measurement of mixed venous oxygen saturation, and have been promoted as a cost-effective, early, and accurate indicator of hemodynamic changes in critically ill patients and patients undergoing major surgical procedures. This retrospective study analyzed two groups of patients undergoing routine, elective coronary artery bypass grafting. In the first group, fiberoptic catheters were not used, whereas these catheters were used routinely in the second group. Multiple variables were analyzed in each group in an attempt to document cost-effectiveness or salutary effect on outcome as a result of the use of these catheters. Neither could be confirmed. It was concluded that the use of Oximetrix pulmonary artery catheters is not cost-effective and had no effect on outcome in this group of patients.

Continuous monitoring of mixed venous oxygen saturation in patients with acute myocardial infarction.

Continuous measurement of mixed venous oxygen saturation (SvO2) has been suggested as an adjunct in monitoring critically ill patients. We evaluated SvO2 monitoring in 24 patients suffering from complicated myocardial infarctions. Cardiac output and arterial lactate levels were measured when there were persistent 5 percent changes in SvO2, and otherwise, every 12 hours or as indicated clinically. Increases in SvO2 by 5 and 10 percent corresponded with an increase in cardiac index in 78.5 percent and 75 percent of measurements, respectively. Decreases in SvO2 by 5 and 10 percent corresponded with decreases in cardiac index in 45.5 percent and 61 percent of measurements. Twenty percent changes in cardiac index showed dissimilar directional changes with SvO2 in 62 percent of cases. Arterial blood lactate levels correlated poorly with SvO2. Survivors had significantly higher mean SvO2 and cardiac indices than nonsurvivors (p less than 0.01). The clinical management of patients with myocardial infarction may not be altered in view of the limitations of SvO2 in reflecting tissue hypoxia. We conclude that continuous monitoring of SvO2 may not be a sensitive measure of cardiac output after acute myocardial infarction.