The neuromuscular effects of 0.6 mg kg(-1) rocuronium in elderly and young adults with or without renal failure.

BACKGROUND AND OBJECTIVES: The elderly represent a wide and increasing patient population and significant numbers of elderly patients have chronic renal disease. This study aimed to investigate the neuromuscular effects of 0.6 mg kg(-1) rocuronium under propofol anaesthesia in young adults and elderly patients with or without renal failure. METHODS: The neuromuscular effects of rocuronium 0.6 mg kg(-1) under propofol anaesthesia were investigated in 40 patients with renal failure undergoing arteriovenous shunt surgery, of whom 20 were young adults (18-50 yr) and 20 were elderly (>65 yr) and in 40 patients with normal renal function undergoing peripheral venous surgery, of whom 20 were young adults and 20 were elderly. Neuromuscular transmission was monitored using acceleromyography. The times to recovery of the twitch (T1) to 25%, 50%, 75% and 90% and of the train-of-four ratio to 70%, and the recovery index were recorded. RESULTS: The times to recovery of the first twitch to 25%, 50%, 75% and 90% and train-of-four to 70% and recovery index were found to be prolonged in both young and elderly patients with renal failure compared to those with normal renal function (e.g. T1 25%: 58.4 +/- 20.2 and 80.1 +/- 23.7 min vs. 32.8 +/- 5.6 and 46.3 +/- 9.0 min, respectively) (P < 0.05). These parameters were also prolonged in the elderly when compared with young adults in both the renal failure and the non-renal failure groups. CONCLUSIONS: The neuromuscular effects of 0.6 mg kg(-1) rocuronium under propofol anaesthesia were markedly prolonged in young and elderly renal failure patients compared to patients with normal renal function, and also in elderly patients with normal renal function compared with young adults.

Infiltration of the sternotomy wound and the mediastinal tube sites with 0.25% levobupivacaine as adjunctive treatment for postoperative pain after cardiac surgery.

BACKGROUND AND OBJECTIVE: This study aimed to investigate the effect of 0.25% levobupivacaine infiltration of the sternotomy wound and the mediastinal tube sites on postoperative pain, morphine consumption and side-effects in patients undergoing cardiac surgery. METHODS: After obtaining Ethics Committee approval and informed consent,50 patients aged 18-65 yr, undergoing coronary artery bypass grafting, were included in this study. Anaesthesia was induced with 5 microg kg (-1) fentanyl, 0.3 mg kg (-1) etomidate, 1 mg kg (-1) lidocaine, 0.1 mg kg (-1) vecuronium and maintained with 1-2% sevoflurane, 50% oxygen in air and fentanyl. Patients were randomized into two groups before sternal wire placement: sternotomy and mediastinal tube sites were infiltrated with either 60 mL 0.25% levobupivacaine (infiltration group, n = 25) or 60 mL saline placebo (control group, n = 25). All patients received intravenous morphine patient-controlled analgesia (bolus dose: 2 mg, lock-out time: 15 min, 4 h limit: 20 mg) after extubation. Postoperative pain at rest and on coughing was assessed by a visual analogue scale (0-10). Pain scores,sedation scores (Ramsay scale), haemodynamic and respiratory parameters, arterial blood gases and morphine consumption were recorded. RESULTS: The times to extubation and visual analogue scale scores were similar between groups. Morphine consumption at 24 h was significantly lower in the infiltration group compared with the control group (29.5 +/- 5.1 vs. 42.8 +/- 4.7 mg, respectively, P < 0.05). The sedation scores were found to be significantly higher in the control group when compared with the infiltration group at 1, 2 and 4 h after extubation (P < 0.05), whereas sedation scores after 4 h were similar between groups. CONCLUSION: Infiltration of the median sternotomy incision and the mediastinal tube insertion sites with 0.25% levobupivacaine in addition to morphine patient-controlled analgesia was found to be effective in reducing postoperative morphine consumption when compared with morphine patient-controlled analgesia alone during the initial 24 h after cardiac surgery.