ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb04028.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The use of neuromuscular blocking drugs during anaesthesia for patients with chronic renal failure is discussed. The disadvantages of the older non‐depolarizing agents, such as tubocurarine, alcuronium, and pancuronium, are outlined, as are the significant benefits of the use of atracurium or vecuronium in these patients. Preliminary reports on the new non‐depolarizing drugs, pipecuronium, mivacurium, doxacurium, and rocuronium are also no

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb04029.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A survey is presented of neuromuscular drug involvement in 590 clinically severe anaphylactoid reactions (grades II‐IV) reported to a Sheffield laboratory from 1988 to the end of 1992 from hospitals throughout the UK. Despite advances in patient monitoring and newer drugs, the reporting frequency and individual drug involvement were remarkably similar to those of a previous report from the laboratory in 1988. The highly immunogenic drug suxamethonium still predominated (48% of reports), but there was now much reduced use of the similarly immunogenic drug, alcuronium. The incidence of reactions to vecuronium and atracurium remained similar (12% and 18% reports, respectively) and acceptable to the anaesthetist. However, in choosing drugs for individual patients, the anaesthetist may wish to note that vecuronium reactors mainly showed bronchospasm, and atracurium reactors hypotension. By a systematic laboratory investigation, based on measurement of plasma tryptase and urinary methylhistamine, reaction mechanisms were assessed in 53 reactions. Despite their overall clinical similarity, analysis revealed that only one reaction in three was likely to be due to IgE‐mediated anaphylaxis (Type 1). Not only was suxamethonium the most frequently reported drug, but in this study 11 reactions were identified as Type 1 response: no allergic reactions were identified for either vecuronium or atracurium, although single cases were identified for alcuronium, gallamine, and tubocurarine, with two unidentified. The remaining reactions were judged to be non‐immune, although most involved mast cell degranulation. These reactions were no less hazardous than Type 1 reactions (one death), and two deaths were recorded. The importance of laboratory investigation as a feature of postreaction care is empha

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb04030.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03830.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Ventilatory failure after administration of neuromuscular blocking agents is an important factor in anaesthesia‐related perioperative morbidity and mortality. Improved knowledge and new monitoring methods may avoid ventilatory failure caused by incomplete recovery of neuromuscular function in the postoperative period. Central respiratory muscles are less sensitive than, and their time course of neuromuscular block is different from those of, pharyngeal muscles and those of the upper airway. Differences in potency and time course of neuromuscular block may lead to incorrect assessment of ventilatory function during onset and recovery. Even if recovery of the mechanical adductor pollicis train‐of‐four (TOF) response to a ratio of 0.70 has previously been associated with adequate ventilatory capacity, it is now shown that hypoxic ventilatory responses may be markedly reduced despite adequate respiratory force at a TOF ratio of 0.70. Hence, partial paralysis may interfere with ventilatory regulation in hypoxaemia. Consequently, monitoring neuromuscular function by peripheral nerve stimulation in one muscle yields limited information about total ventilatory capacity, especially the function of the upper airway and ventilatory regulation. Therefore, neuromuscular monitoring should be used with caution during recovery and should always be combined with bedside clinical tests if pos

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb04031.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03831.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Previous studies have shown that infusion of propofol has sometimes been associated with bradyarrhythmias. To evaluate the effects of propofol on the electrical system of the heart, we carried out an electrophysiologic study with transesophageal pacing on ten healthy subjects scheduled for minor elective maxillo–facial surgery. By means of atrial pacing conducted by a progressive increase in stimulation cycles, we determined, in awake patients and during propofol anesthesia (2.5 mg kg‐1for induction, followed by 100 μg kg‐1min‐1for maintenance), the correct sinus recovery time and the eventual appearance of Wenckebach atrio–ventricular block. We did not notice sinoatrial node depression or pathologic increase in the atrio–ventricula

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03832.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In an intensive–care setting we studied the effects of ketoprofen, a dual inhibitor of cyclooxygenase and lipoxygenase, on circulatory and respiratory changes during established endotoxic shock in sheep. Two groups (n = 7 in each) were exposed toE. coliendotoxin, which caused a sharp increase in pulmonary artery pressure (200%; PAP), intrapulmonary shunt fraction (300%; Qs/QT%), and oxygen extraction ratio (50%; Vo2/ Do2%). There was also a significant decrease in mean arterial pressure (25%; MAP), respiratory compliance (60%; CT), arterial oxygen tension (65%; Pao2), and oxygen delivery index (15%; Do2) in both groups. After 30 min of endotoxin infusion, group K received ketoprofen, 2.5 mg/kg b.w. i.v., while group E served as shock controls. After 4 h there had been a significant improvement in MAP, Pao2, Do2, Qs/QT%, and CTin the ketoprofen–treated group compared with the controls (P<0.01). In addition, the oxygen extraction ratio normalised in group K, but remained 70–100% increased in group E (P<0.01). The wet–to–dry weight ratios of the lungs and the liver were significantly lower in the ketoprofen–treated group compared with the controls (P<0.05). It was concluded that ketoprofen significantly ameliorated the respiratory and circulatory effects of established endotoxic sho

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03833.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Twelve otherwise healthy male volunteers scheduled for arthroscopy of the knee were studied. The influencein vivoof nitrous oxide (N2O)per seand the addition of a halogenated volatile anaesthetic (halothane or isoflurane) on ADP–induced platelet aggregation and release of beta–thromboglobulin into plasma was evaluated. All measurements were made before surgery. We found that N2O increased platelet aggregation. Adding a halogenated anaesthetic reversed the relative hyperaggregation induced by NaO. The concentrations in plasma of the platelet release product beta thromboglobulin were not influenced by the anaesthet

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03834.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Intraoperative arousal was evaluated in 24 patients (median age 16.5 years), undergoing spondylodesis with Cotrel–Dubousset or Harrington–Luque instrumentation. Flumazenil and placebo groups of 12 patients each were similar with respect to age, body weight, dosage of anaesthetic drugs and surgery times. Premedication consisted of diazepam 0.2–0.3 mg kg‐1orally. Anaesthesia was induced with thiopentone 5–7 mg kg‐1, and maintained with 66% nitrous oxide in oxygen, and repeated doses of fentanyl, midazolam and atracurium. After placement and fixation of the metal rods, N2O was switched off, and either flumazenil or placebo was given in refracted doses until the patient responded to command. Intraoperative motor response times (medians with ranges), defined as the time from the injection of the first dose until the patient responded to command, were 2.5 min (1.0–5.2 min) after flumazenil, and 8.0 min (1.7–28.5 min) after placebo (P= 0.02). Five patients in the placebo group did not wake up within 10 min and received naloxone. The quality of awakening was similar in both groups. Two patients (one in each group) woke up violently and needed physical restraint. Postoperatively, motor responses were assessed after 12.0 min (5–42 min) in the flumazenil group, and after 15.2 min (4–40 min) in the placebo group (NS). Recovery from anaesthesia took 27.5 min (7–415 min) in the flumazenil group, and 25.0 min (8–160 min) in the placebo group (NS). One patient given flumazenil and one patient given placebo remembered moving their feet, but neither of them could recall anything unpleasant. It is concluded that flumazenil significantly shortens the time of intraoperative arousal during scoliosis surgery under midazolam, N2O/O2anaesthesia, without having to compromise the analgesia provided by fentanyl. Flumazenil does not facilitate postoperative motor testing or recovery, nor does it affect recall of th

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03835.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY