Inadvertent infusion of potassium chloride via an epidural catheter.

A 73-year old man underwent a segmental liver resection for a solitary liver metastasis from a rectal carcinoma. On post-operative day one, an accidental potassium chloride infusion (total 29 mmol or 1135 mg of KCl) was given via the epidural catheter. Within a few hours this resulted in pruritus, progressive muscle spasms, decreased consciousness and vegetative symptoms such as tachycardia and hypertension. Subsequently respiratory insufficiency developed, necessitating intubation and ventilation of the patient with admission to the Intensive Care Unit. The patient received a single dose of 40 mg of dexamethasone intravenously to prevent or decrease possible myelum edema, and 100 ml x h(-1) of NaCl 0.9% infusion over the epidural catheter for several hours. The patient made a complete recovery, was extubated successfully six hours after ICU-admission and discharged home free of symptoms.

Comparative study of etomidate-alfentanil anesthesia with N2O/O2 or with air/O2.

Systolic, diastolic blood pressures, heart rate, glycaemia, blood gases and clinical status were studied preinduction, 10' after anesthesia induction and intubation, 3', 30', 60' and 90' after surgical incision, when awake on the operating table and 60' after awakening in 20 hysterectomy patients. Etomidate (0.3 mg/kg + continuous infusion), alfentanil (75 micrograms/kg + increments of 15 micrograms/kg) anesthesia was used with a N2O/O2 mixture (10 pt) or with air/O2 (10 pt), both at a FIO2 = 0.33. This technique gave a smooth induction and recovery. Cardiovascular changes were moderate. The additional dose of alfentanil was 5.25 +/- 0.65 mg in the N2O/O2 group and 6.45 +/- 0.85 mg in the air/O2 group. The incidence of vomiting was 15%. Statistical analysis of both groups indicated no major difference between the two types of anesthesia, for the cardiovascular, acid base data and glycaemia. This technique is a simple and effective way of anesthetising patients, but from a clinical point of view the etomidate/alfentanil anesthesia combined with N2O/O2 gives better results than when combined with air/O2.

Alfentanil/etomidate anaesthesia for endolaryngeal microsurgery.

Anaesthesia for laryngeal microsurgery by laser was conducted using etomidate and alfentanil. Patients' lungs were ventilated with air to avoid the danger of fire during the use of the laser. Thirty one patients received fentanyl/droperidol or pethidine for premedication. Anaesthesia was induced with etomidate 300 micrograms/kg and maintained with etomidate 30 micrograms/kg/minute. Alfentanil was given as an initial bolus of 40 micrograms/kg with subsequent increments of 15 micrograms/kg. Systolic arterial blood pressure and heart rate decreased significantly at some time intervals. Blood biochemistry and blood gases were within normal ranges, except for elevated PaO2 values during ventilation on pure oxygen. This technique adequately provided the requirements for prompt, smooth awakening, with a low incidence of nausea and vomiting.

Clinical use of vecuronium (ORG NC 45) in balanced anesthesia. Comparison with pancuronium.

In 2 groups of 25 patients 0.1 mg/kg vecuronium (Org NC 45) or pancuronium, according to a randomised basis, was injected during balanced anesthesia (thiopental, fentanyl, dehydrobenzperidol and N2O). Intubation conditions 120 seconds after injection were satisfactory. After intubation, a heart rate increase was present with pancuronium (p less than 0.01), but not with vecuronium (difference: p less than 0.05); heartrate decreased 15 and 30 minutes after injection of vecuronium (p less than 0.01). The clinical duration of action of vecuronium was 32.7 +/- 2.4 min (Mean +/- SEM) and of pancuronium 73.5 +/- 4.8 min (p less than 0.01). Successive maintenance doses of 0.025 mg/kg of vecuronium had a duration of action of 23.1 +/- 1.7, 26.8 +/- 2.1, 27.6 +/- 4.0 and 24.0 +/- 2.8 min (diff. NS), showing no cumulative activity. The duration of action of identical doses of pancuronium were 56.9 +/- 3.1, 52.1 +/- 7.2 and 61.3 +/- 17.6 min (diff. NS), values nearly +/- 220% above those of vecuronium (p less than 0.01). Reversion of neuromuscular blockade after vecuronium with small amounts of neostigmine was clinically adequate.