[Recovery of neuromuscular block after continuous infusion of cisatracurium in patients with renal dysfunction]. / Récupération du bloc neuromusculaire après perfusion continue de cisatracurium chez l'insuffisant rénal.

OBJECTIVE: Study of the recovery of neuromuscular block after continuous infusion of cisatracurium in patients with renal dysfunction. STUDY DESIGN: Prospective case-control study. PATIENTS: Forty adult patients scheduled for urological surgery were assigned to two groups according to the creatinine clearance (CC) as a measure of the renal function: group IR (CC < 60 mL.min-1) or group NR (CC > or = 60 mL.min-1). METHODS: After premedication with hydroxyzine, anaesthesia was induced with propofol, sufentanil and cisatracurium (0.15 mg.kg-1), and maintained using isoflurane, sufentanil and a continuous infusion of cisatracurium (0.12 mg.kg-1.h-1) adjusted for maintained a post-tetanic count < or = 5. Neuromuscular transmission was monitored at the adductor pollicis using accelerography (TOF Gard). Onset and recovery times in both groups were compared using Student's t test. RESULTS: Infusion time and total dose of cisatracurium were comparable in both groups. Onset times were 3.9 +/- 0.8 min and 3.5 +/- 0.6 min in groups IR and NR respectively. After the infusion, the time to train-of-four ratio of 0.8 were not different in both groups: 77 +/- 18 min (group IR) and 73 +/- 13 min (group NR). However, the spontaneous recovery intervals 25%-75% were delayed in group IR (20 +/- 9 min vs 14 +/- 5 min p < 0.05). CONCLUSION: There are minor differences in the pharmacodynamics of cisatracurium between patients with normal or impaired renal function. Nevertheless, a marked interindividual variability in the recovery parameters was observed in patients with renal dysfunction.

[Patient-controlled sedation with propofol for extracorporeal shock wave lithotripsy]. / Sédation contrôlée par le patient avec du propofol au cours de la lithotritie extracorporelle rénale.

OBJECTIVE: Evaluation of patient-controlled sedation with propofol for extracorporeal shock wave lithotripsy (ESWL) using an EDAP LT01 lithotriptor. STUDY DESIGN: Prospective clinical study. PATIENTS: Fifty consecutive patients, ASA I or II, aged 18-65 years. METHODS: Patients received 50 mg of propofol five minutes before ESWL, then they self-administered 50 mg bolus doses of propofol with a ten minutes lock-out interval. Pain (1-100 mm VAS) and sedation (four points scale) were assessed every five minutes. Patient satisfaction was recorded at the end of the procedure. Pharmacokinetic simulation was done with the Marsh's data set. RESULTS: Three patients were excluded. Patients received a mean propofol dose of 147 +/- 68 mg during the procedure with a mean duration of 47 +/- 8 minutes. The median of the higher sedation scores was 2 (drowsy) and mean maximal VAS was 40 +/- 20 mm (10-70). No complications were recorded. Thirty-nine patients (83%) were satisfied or very satisfied by patient-controlled sedation. CONCLUSION: Patient-controlled sedation with propofol is a safe and efficient mode of administration of an hypnotic agent for ESWL.