ABSTRACT
Our clinical experience has shown that the use of a constant distending airway pressure of 30 cm water for 10 s, termed a timed reexpansion inspiratory manoeuvre (TRIM), is often successful in correcting oxyhaemoglobin desaturation in anaesthetized children. The aim of this study was to assess the efficacy of TRIM in lambs. Following a standard relaxant anaesthetic, ventilation was stopped and oxyhaemoglobin saturation allowed to fall to 70% and the time taken to return to baseline was compared between three groups. The median time was 42.5 s when ventilation was restarted with 33% oxygen in nitrous oxide (33% group), 30 s when ventilation was restarted with 100% oxygen (100% group) and 22.5 s with a TRIM before restarting ventilation with 33% oxygen in nitrous oxide (TRIM group). The correction of desaturation was more rapid in the TRIM group compared with the 33% group (P < 0.004) and the 100% group (P < 0.003). Oxyhaemoglobin desaturation due to apnoea in anaesthetized lambs is more effectively treated with a TRIM than by increasing the inspired oxygen fraction.
Subject(s)
Anesthesia, General/adverse effects , Apnea/therapy , Oxygen Inhalation Therapy , Oxyhemoglobins/metabolism , Respiration, Artificial , Animals , Animals, Suckling , Apnea/blood , Child , Humans , Intraoperative Period , Lung Volume Measurements , SheepABSTRACT
We have assessed, in children aged three to eight years, the intubating conditions after administration of rocuronium 0.6 mg/kg at 50 or 60 seconds, in groups of 15 patients. Intubating conditions were excellent in 11, good in 3 and fair in 1 patient at 50 seconds and excellent in 12 and good in 3 patients at 60 seconds. The mean onset time, for all patients, to when the first twitch of the train of four (T1), measured at the adductor pollicis, was depressed to less than 30% and 5% of control was 50 (SD 11.4) seconds and 94 (SD 31.7) seconds respectively. Depression of T1 to less than 30% of control, measured at the adductor pollicis in children, appears to indicate that intubating conditions will be clinically acceptable when using rocuronium.
Subject(s)
Androstanols , Neuromuscular Blockade , Neuromuscular Nondepolarizing Agents , Androstanols/administration & dosage , Child , Child, Preschool , Female , Humans , Intubation, Intratracheal , Male , Neuromuscular Nondepolarizing Agents/administration & dosage , Rocuronium , Time FactorsABSTRACT
We have investigated 195 pre-menopausal women undergoing third molar extractions, in a prospective study, to assess the influence of the day of the menstrual cycle on the incidence of postoperative nausea or vomiting. In the 95 patients taking the oral contraceptive pill the incidence of postoperative nausea or vomiting was higher on days 9 to 15 of the menstrual cycle (P < 0.05) than on days one to eight and days 16 to the end of cycle. In the 100 patients who were not taking the oral contraceptive pill the incidence of postoperative nausea or vomiting was not higher on days 9 to 15. The strongest predictor for postoperative nausea or vomiting in our study was a previous episode of postoperative nausea or vomiting (P < 0.005). Patients with a tendency to motion sickness did not have a higher incidence of postoperative nausea or vomiting.
Subject(s)
Menstrual Cycle/physiology , Molar, Third/surgery , Nausea/etiology , Tooth Extraction/adverse effects , Vomiting/etiology , Adolescent , Adult , Anesthesia, Dental , Anesthesia, General , Contraceptives, Oral/therapeutic use , Female , Forecasting , Humans , Incidence , Motion Sickness/complications , Premenopause , Prospective Studies , Respiration, Artificial , Risk Factors , Succinylcholine/administration & dosageABSTRACT
We have investigated the effect of augmentation of propofol with alfentanil for nasotracheal intubation without neuromuscular block in 60 patients undergoing short elective maxillo-facial procedures as outpatients. After administration of glycopyrronium 5 micrograms kg-1 i.v., anaesthesia was induced with propofol 2.5 mg kg-1, or alfentanil 20 micrograms kg-1 and propofol 2.5 mg kg-1. The alfentanil group had improved jaw relaxation (P < 0.001) and vocal cord conditions (P < 0.005). Tracheal intubation was successful in 83% of patients receiving alfentanil, and in 73% of patients receiving propofol only. This difference was not significant. The cardiovascular response to intubation was attenuated in the alfentanil group.
Subject(s)
Alfentanil , Intubation, Intratracheal , Propofol , Adolescent , Adult , Anesthesia, Intravenous , Drug Synergism , Face/surgery , Humans , Middle Aged , Orthognathic Surgical ProceduresABSTRACT
We have investigated 60 patients in a prospective double-blind, placebo-controlled study to assess the efficacy of EMLA (Eutectic Mixture of Local Anaesthetics) cream to provide analgesia during extracorporeal shock wave lithotripsy (ESWL) with a second generation lithotriptor. Before operation, EMLA or placebo cream was applied to the patient's back at the anticipated shock head-skin interface. During the procedure increments of fentanyl 0.5 micrograms kg-1 were given i.v. on patient demand. There was no significant difference (P = 0.83) in the dose of fentanyl given to each group. We cannot recommend, therefore, the use of EMLA cream as an analgesic during ESWL with a second generation lithotriptor.
