Prolonged neuromuscular blockade when mivacurium and pancuronium were administered in series.

Long acting non-depolarizing neuromuscular blockade is useful in many clinical circumstances, especially during surgical procedures. Reinstitution of the blockade for short periods to facilitate the completion of clinical tasks can be accomplished in different ways. We present a case wherein a short-acting non-depolarizing neuromuscular blocker used after a long-acting one resulted in an unusual prolongation of the neuromuscular blockade.

Role of adenosine in the diagnosis and treatment of postoperative supraventricular tachyarrhythmias.

Adenosine (Adenocard) has a potent but very transient negative dromotropic effect on atrioventricular (A-V) nodal conduction. By slowing A-V nodal conduction, adenosine may interrupt a re-entry pathway causing paroxysmal supraventricular tachycardia or facilitate the diagnosis of other supraventricular tachycardia (SVT) by exposing the underlying atrial activity. We report 15 postoperative cases in which adenosine was used to clarify the diagnosis of postoperative SVT, and allowed the appropriate postoperative care.

A comparison of the Puritan-Bennett 7200a ventilator's flow-by mode to the T-piece mode prior to extubation in postsurgical patients.

UNLABELLED: We compared flow-by ventilation (FB) via the Puritan-Bennett 7200a ventilator with T-piece ventilation (TP) during weaning from mechanical ventilation (MV). METHODS: We placed 22 consecutive postsurgical patients being weaned from MV on FB at base flows of 10 L/min and 20 L/min and then on TP. Blood pressure, pulse rate, respiratory rate, blood gases, tidal volume, and peak inspiratory flow were measured after at least 20 min in each mode. Statistical analysis of clinical status used a three-level, one-way analysis of variance with technique as a within-subjects factor. Setup costs of the three ventilatory modes were evaluated using relative value units for labor plus actual costs of added equipment and supplies. RESULTS: Although there was a statistically significant difference in PaCO2 among the ventilatory modes, this was not clinically important. No other differences were found. Each FB mode cost $2.55 to set up, whereas TP cost $11.90. CONCLUSIONS: FB and TP were clinically equivalent. However, the alarm and monitoring capabilities during FB are useful and may be worth the one-time cost ($1,000) of adding the optional flow-by software to the 7200a ventilator.