Spinal vs general anesthesia: the patient's perspective.
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Anesthesia, General↗
Biomedical subjects
P Drolet
Publications and source records attributed to P Drolet.
[Locoregional neuraxial anesthesia and vascular surgery: the benefits].
PURPOSE: To assess the advantages of neuraxial blockade (NB) during and after vascular surgery and to confront them with the risk of epidural or spinal hematoma. MAIN FINDINGS: NB may reduce the risk of thrombotic occlusion following lower extremity vascular reconstruction. This effect of NB may be attributed to reduced hypercoagulability, decreased peripheral resistance and increased graft flow. In patients under general anesthesia, only those authors using an aggressive perioperative management (pulmonary artery catheter monitoring, intensive care unit admission) were able to report grafts patency rates similar to those obtained with NB. NB facilitates the modulation of the hemodynamic and hormonal stress responses during the perioperative period. It also produces superior postoperative analgesia. Still, the impact of NB on cardiac morbidity following aortic reconstructive surgery remains open to debate. Only very few cases of epidural hematomas associated to NB following vascular surgery have been reported. They implicated patients who received either fibrinolytic medication, continuous heparin infusion, or both. Low molecular weight heparins may increase the risk or epidural hematoma and, should their administration become more frequent during vascular surgery, the safety of NB would then have to be reassessed. CONCLUSION: NB during vascular surgery is a safe and well-established practice. It offers many theoretical and demonstrated advantages. NB is particularly beneficial and economical for lower extremity vascular reconstruction. Still, NB may not be the best approach if the administration of fibrinolityc medication or prolonged heparin infusion is contemplated.
Anesthesia, Conduction↗
Intrathecal fentanyl does not modify the duration of spinal procaine block.
PURPOSE: To document the clinical characteristics of spinal procaine with or without the addition of fentanyl in light of the failure rate observed previously with procaine 10%. METHODS: In a randomized, prospective, double-blind study, 52 patients received spinal anesthesia with 100 mg procaine and either saline 0.9% (0.4 ml) (CONTROL group) or 20 microg fentanyl (0.4 ml) (FENTANYL group). Sensory anesthesia to needle prick was evaluated each minute for ten minutes, every three minutes for 33 minutes and every five minutes until regression to T10. Motor block was assessed with the Bromage scale. Patients were questioned by telephone for pain suggesting transient radicular irritation (TRI) 48 hr later. RESULTS: Mean time to reach highest sensory level, maximum number of segments blocked and mean time for regression of the sensory level to T10 showed no difference. Time to recuperate to full flexion of knees and feet (Bromage 4) showed no difference. Nine patients had nausea (five in CONTROL group and four in FENTANYL group) and nine had pruritus (three in CONTROL group and six in FENTANYL group). No patient reported pain suggesting TRI. CONCLUSION: Spinal procaine is appropriate for short-duration surgery. Fentanyl does not change the characteristics of the block or the incidence of side effects associated with spinal procaine.
Adolescent↗
Spinal anesthesia: a comparison of procaine and lidocaine.
PURPOSE: To compare spinal procaine to spinal lidocaine with regard to their main clinical characteristics and incidence of transient radicular irritation (TRI). METHODS: In this randomized, double-blind, prospective study, patients (two groups, n=30 each) received either 100 mg of lidocaine 5% in 7.5% glucose (Group L) or 100 mg of procaine 10% diluted with 1 ml cerebrospinal fluid (Group P). After spinal anesthesia, segmental level of sensory block was assessed by pinprick. Blood pressure and the height of the block were noted each minute for the first ten minutes, then every three minutes for the next 35 min and finally every five minutes until regression of the block to L4. Motor blockade was evaluated using the Bromage scale. To evaluate the presence of TRI, each patient was questioned 48 hr after surgery. RESULTS: Time to highest sensory level and to maximum number of segments blocked showed no difference between groups. Mean time for sensory regression to T10 and for regression of the motor block were shorter in Group P. Eighty minutes following injection, sensory levels were lower in Group P. Five patients had inadequate surgical anesthesia in Group P and only one in Group L. No patient in Group P had TRI (95% CI 10-12%) while eight (27%) in Group L did (95% CI 12-46%). CONCLUSIONS: Procaine 10% was associated with a clinical failure rate of 14.2%. This characteristic must be balanced against an absence of TRI, which occurs more frequently with the use of lidocaine 5%.
Adult↗
Music decreases sedative requirements during spinal anesthesia.
UNLABELLED: Ambulatory surgery can create significant anxiety. This prospective study measured whether music can influence anxiety and perioperative sedative requirements in outpatients undergoing surgery with spinal anesthesia. We also evaluated the correlation between two anxiety measures, the State-Trait Anxiety Inventory test (STAI) and the 0- to 10-cm visual analog scale (VAS 0-10), with 0 meaning complete relaxation and 10 the worst feeling of anxiety possible. Fifty unpremedicated patients were randomly assigned to listen to music of their choice via headset during the perioperative period (Group I) or to have no music (Group II). All participants used patient-controlled IV midazolam sedation and underwent repeated evaluations of their anxiety level with the STAI and the VAS 0-10. Midazolam requirements during surgery (Group I, 0.6 +/- 0.7 versus Group II, 1.3 +/- 1.1 mg; P < 0.05) and for the whole perioperative period (Group I, 1.2 +/- 1.3 versus Group II, 2.5 +/- 2.0 mg; P < 0.05) were smaller in patients listening to music. Anxiety levels, measured with STAI or VAS 0-10, were similar in both groups. The Spearman's coefficient values between STAI and VAS 0-10 ranged from 0.532 to 0.687. We conclude that patients listening to music require less midazolam to achieve a similar degree of relaxation as controls and that measures of anxiety obtained from the STAI and the VAS 0-10 are positively, but only moderately, correlated. IMPLICATIONS: It is possible to decrease sedative requirements during surgery under spinal anesthesia by allowing patients to listen to music to reduce their anxiety.
Adult↗
Facilitating submental endotracheal intubation with an endotracheal tube exchanger.
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Adult↗
Spinal procaine with and without epinephrine and its relation to transient radicular irritation.
PURPOSE: To document the clinical characteristics of procaine with or without the addition of epinephrine. METHODS: In this randomized, prospective, double blind study, 62 patients received spinal anesthesia with 100 mg procaine and either 0.3 mg epinephrine (EPI group) or 0.3 ml NaCl 0.9% (SALINE group). Sensory anesthesia to needle prick was evaluated q 1 min for 10 min, q 3 min for 33 min and q 5 min until regression to L4. Motor block was assessed with the Bromage scale. Patients were questioned, by telephone, for transient radicular irritation (TRI) 48 hr later. RESULTS: Time to reach highest sensory level and number of segments blocked showed no difference. Mean time for regression of the sensory level to T10 was longer in EPI (83 +/- 23 vs 66 +/- 20 min, P < 0.01). Time to recuperate to full flexion of knees and feet (Bromage 4) was longer in EPI (126 +/- 37 vs 100 +/- 30 min, P < 0.01). Patients in EPI received more ephedrine. Eighteen patients had nausea (15 EPI/3 SALINE, P < 0.0015). One patient had TRI, incidence: 1.67%, 95% CI (< 1%-9%). CONCLUSION: Spinal procaine is appropriate for surgery of short duration. Epinephrine prolongs sensory and motor blocks by 25%. However, it is associated with a high incidence of nausea.
Adult↗
Effect of the laryngeal mask airway on oesophageal pH: influence of the volume and pressure inside the cuff.
We studied gastro-oesophageal reflux (GOR) with a face mask and laryngeal mask airway (LMA), and the effects of inflation pressure and volume of the LMA cuff on oesophageal pH, in 60 patients. Patients were managed with either a face mask (group I) or LMA inflated to obtain a seal in the anaesthesia circuit at 7 cm H2O (group II) or 15 cm H2O (group III). A pH-sensitive probe with two electrodes, 10 cm apart, was placed in the oesophagus during anaesthesia and recordings were made continuously until patients awakened. There was a significant difference in the incidence of GOR between the face mask (group I) and the LMA (groups II-III) (P < 0.05) in the lower oesophagus but there was no difference in the mid-oesophagus. No correlation was found between pressure and volume inside the cuff and variations in oesophageal pH. We conclude that LMA use was associated with increased reflux in the low oesophagus but oesophageal pH was not influenced by variations in pressure or volume inside the LMA cuff.
Adult↗
Tuohy needles and CSE.
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Anesthesia, Epidural↗
In vitro response to oxytocin and interferon-Tau in bovine endometrial cells from caruncular and inter-caruncular areas.
Caruncules are differentiated sites of the endometrium in which placentation occurs in ruminants. We investigated whether the response to agents involved at the time of recognition of pregnancy differed in the caruncular (CAR) and inter-caruncular (ICAR) areas of the endometrium in vitro. The specialization in prostaglandin (PG) production previously described in cells from whole endometrium was reproduced in the CAR and ICAR areas: PGF2alpha and PGE2 were produced in greater proportions, respectively, in epithelial and stromal cells. The relative production of PGE2 was equivalent in epithelial cells from CAR and ICAR regions, but the production of PGF2alpha was higher (p < 0.05) in the ICAR region (2.2 +/- 0.5 vs. 4.0 +/- 0.2 ng/ microg DNA, respectively). In stromal cells, the ICAR area produced more PGE2 than did the CAR area (3.4 +/- 0.4 vs. 2.1 +/- 0.4 ng/ microg DNA, p < 0.05), and the respective PGE2:PGF2alpha ratio was significantly higher in the ICAR area (p < 0.05). The production of PGs was measured first in response to oxytocin (OT, 10(-9) to 10(-5) M) and then to recombinant ovine interferon-tau (roIFN-tau, 0.02 to 20 microg/ml) in a separate set of experiments. In epithelial cells, OT stimulated the production of PGF2alpha 6.3-fold in the CAR area and more than 33.0-fold in the ICAR area (7.1 +/- 3.2 vs. 36.3 +/- 9.8 ng/ microg DNA, respectively, p < 0.05). Production of PGE2 was also increased in both regions and reached a plateau at 4.1 +/- 0.4 ng/ microg DNA. In epithelial cells from the ICAR but not the CAR region, the PGE2:PGF2alpha ratio was decreased in the presence of OT (p < 0.05). In separate experiments, addition of roIFN-tau stimulated PGE2 production significantly (p < 0.05), and no difference (p > 0.8) was observed between CAR and ICAR regions. An increase in PGE2:PGF2alpha ratio was observed in epithelial cells from both CAR and ICAR regions, but it was significant only in the CAR region (p < 0.05). In stromal cells, roIFN-tau stimulated PGE2 production significantly in cells from the CAR and ICAR regions (35.6 +/- 2.9 vs. 24.1 +/- 3.8 ng/ microg DNA, respectively, p < 0.05). In summary, the ICAR region seems to be the privileged site for regulation of PGF2alpha production by OT, but the caruncules may be a preferred site for recognition of the embryonic IFN-tau signal. Endometrial cells from the CAR and ICAR areas appear to exhibit specialized responses, with cells from the ICAR region more responsive to OT and those from the CAR region more sensitive to roIFN-tau.
Animals↗
Ontogeny of oxytocin receptors and oxytocin-induced stimulation of prostaglandin synthesis in prepubertal heifers.
Developmental aspects of oxytocin (OT) receptors (OTR) in uterine tissues before puberty are not known. Bovine ovaries secrete some estradiol, but no progesterone, before puberty; the circulating levels of estradiol are between 1 and 3 pg/ml until puberty. Cross-bred Angus-Brahman heifers, in which puberty occurs around 12 months of age, were used to determine the concentrations of OTR from the late fetal stage to adulthood. PGF2alpha release in response to OT was determined in 3-, 6-, and 9-month-old heifers (n = 4 each). Myometrium, endometrium, and cervical mucosa were obtained from 3-week-old, 3-month-old, 6-month-old, and 9-month-old heifers and from adult cows at estrus. Whole uterus and cervix were taken from third trimester fetuses and at birth. [3H]OT binding and specificity, localization of immunoreactive (ir) OTR, OTR messenger RNA, and OT-induced release of PGF2alpha were determined. The uterus from fetuses and the neonate expressed OTR messenger RNA and bound [3H]OT. At 3 weeks of age, OTR concentrations per mg protein were very low, but at 3 months of age they had increased markedly in all three tissues. At 6 and 9 months of age, levels of OTR had risen further and were similar to those in adult cows at estrus. Prepubertal uterus also possessed separate vasopressin VP1 subtype receptors. The ir-OTR was localized in luminal epithelial cells of endometrium and cervical mucosa, most of which were ir positive, whereas in myometrium, clusters of ir-OTR-positive cells were found among large numbers of ir-OTR-negative cells. The PGF2alpha response to OT was insignificant in heifers of all age groups, in contrast to that in cows at estrus. Endometrial cells from 4- to 5-month-old heifers did not respond to OT with PG release in the absence or presence of added arachidonic acid. Tumor promoters, lipopolysaccharide, and interleukin-2 also failed to elicit PG release in vitro, although they induced PG release in similar cell cultures from cyclic cows. In summary, uterine tissues of prepubertal heifers have high levels of OTR, which appear to be developmentally regulated. These receptors are not coupled to PG synthase, or alternatively, the PG synthase gene is not expressed before puberty, possibly because the tissues have had no previous exposure to progesterone.
Animals↗
Direction of injection does not affect the spread of spinal bupivacaine in parturients.
PURPOSE: One of the factors that can affect the distribution of local anaesthetic solutions in the subarachnoid space is the direction of the spinal needle through which injections are made. This study investigated the effect of the direction of the aperture of the Whitacre needle on the spread of hyperbaric bupivacaine in parturients undergoing elective caesarean section. METHODS: Forty healthy term parturients scheduled for caesarean delivery under spinal anaesthesia with 12 mg hyperbaric bupivacaine + 0.2 mg morphine were randomly assigned to one of two groups: needle orifice cephalad (I) or caudad (II). Spinal blocks were administered in the sitting position with patients being positioned supine immediately after. A blinded observer assessed the dermatome level of analgesia to ice every minute for the first 10 minutes, every three minutes for the following 35 min, then every 15 min until the sensory level regressed to T10. RESULTS: There was no difference between the groups regarding the maximal number of segments blocked cephalad to T11 (11.4 +/- 3.4: group I and 12.0 +/- 3.4: group II), time to highest cephalad spread of sensory block (22 +/- 10: group I and 19 +/- 10 min: group II), or time to regression to T10 (164 +/- 26: group I and 153 +/- 24 min: group II). The maximum decrease in blood pressure (33.9 +/- 9.6: group I and 36.8 +/- 11.8 mmHg: group II) and dosage of ephedrine administered (14.7 +/- 10.7: group I and 16.2 +/- 11.0 mg: group II) did not differ. CONCLUSION: The direction of the aperture of the Whitacre needle does not influence the spread of hyperbaric bupivacaine in the term parturient.
Adult↗
Comparison of rocuronium and d-tubocurarine for prevention of succinylcholine-induced fasciculations and myalgia.
PURPOSE: We compared d-tubocurarine and rocuronium for the prevention of succinylcholine-induced fasciculations and postoperative myalgia (POM) and evaluated the influence of both drugs on the speed of onset and recovery of succinylcholine. METHODS: Seventy-five women undergoing surgery of short duration were studied. They were randomized to one of three groups: group SAL received normal saline followed three minutes later by 1.0 mg.kg-1 succinylcholine; group ROC received 0.05 mg.kg-1 rocuronium + 1.5 mg.kg-1 succinylcholine; group DTC received 0.05 mg.kg-1 d-tubocurarine + 1.5 mg.kg-1 succinylcholine. Single-twitch stimulation was applied to the ulnar nerve every 10 sec and the EMG response of the adductor pollicis was recorded. Fasciculations were assessed by a blinded observer on a scale of 0-3. Patients were asked 24 and 48 hr later to rate POM using a scale of 0-10. RESULTS: The interval needed for twitch height to decrease to 10% of initial value after succinylcholine was longer in group ROC (58 +/- 20 sec) (mean +/- SD) compared with group SAL (44 +/- 13 sec) (P < 0.05). Recovery to 20% occurred faster in group ROC (324 +/- 83 sec) than in groups SAL (456 +/- 103 sec) and DTC (450 +/-132 sec) (P < 0.05). Fasciculations were more intense in groups SAL than in groups ROC and DTC (P < 0.001). Patients rated POM as less intense 24hr postoperatively only in group ROC (1.2 +/- 2.4) compared with group SAL (3.3 +/- 3.5) (P < 0.05). CONCLUSION: Rocuronium prevents succinylcholine-induced fasciculations and POM. Rocuronium also delays the onset of succinylcholine and shortens its duration compared with d-tubocurarine.
Adolescent↗
Cellular mechanisms involved during oxytocin-induced prostaglandin F2alpha production in endometrial epithelial cells in vitro: role of cyclooxygenase-2.
PGs are important regulators of reproductive processes. At the time ofluteolysis in vivo, PGF2alpha is produced by endometrial cells, in response to oxytocin (OT). The mechanism by which OT induces the release of PGF2alpha remains to be defined. We have used 13 different cultures of bovine epithelial endometrial cells to study the effect of OT on the regulation of PGF2alpha and to identify the possible involvement of cyclooxygenases (COXs). OT induced a dose-dependent increase of both inositol phosphates (IPs) and [Ca2+]i concentration in epithelial cells labeled with [3H]-myoinositol or loaded with fura-2 (using a fluorescent microscope imaging system), respectively. OT induced a dose-dependent increase of both PGF2alpha production and COX-2 gene expression (as demonstrated by RT-PCR and Northern blots). PGF2alpha production was increased from 13.3 +/- 2.0 to 166.8 +/- 22.5 ng/ml (P < 0.0001). On the other hand, COX-2/beta-actin mRNA gene expression (as determined by densitometric analysis) was increased 5.1 +/- 0.7-fold (P < 0.001) with OT (10[-7] M) treatment, compared with control. Addition of indomethacin (1 microM) and a specific COX-2 inhibitor (NS-398, 1 microM) blocked the OT-induced PGF2alpha production. COX-1 and phospholipase A2 mRNA were expressed at steady-state levels, but no effect of OT was detected on their regulation. Combined to OT, 10 microq/ml of recombinant ovine interferon-tau (roIFN-tau) was able to decrease significantly (P < 0.0001) the dose-dependent increase of PGF2alpha production. Furthermore, partial bovine COX-1 (777 pb) and COX-2 (449 bp) cDNAs were cloned and sequenced. An homology of 83% and 97% was found in relation with rat and sheep, for COX-1, respectively. COX-2 was found to bear 84%, 86%, and 87% of homology in relation to rat, guinea pig, and human, respectively. Collectively, these results demonstrate, for the first time, that COX-2 is involved in the mechanism by which OT regulates PGF2alpha production in the endometrium.
Amino Acid Sequence↗
Inhibition of the T-type Ca2+ current by the dopamine D1 receptor in rat adrenal glomerulosa cells: requirement of the combined action of the G betagamma protein subunit and cyclic adenosine 3',5'-monophosphate.
Modulation of ionic Ca2+ currents by dopamine (DA) could play a pivotal role in the control of steroid secretion by the rat adrenal glomerulosa cells. In the present study, we report that DA decreases the T-type Ca2+ current amplitude in these cells. The use of pharmacological agonists and antagonists reveals that this effect is mediated by activation of the D1-like receptors. Modulation by cAMP is complex inasmuch as preincubation of the cells with 8-Br-cAMP or the specific adenylyl cyclase inhibitor, 2',3'-dideoxyadenosine, have no effect per se, but prevent the DA-induced inhibition. The inhibitory effect of DA was abolished by addition of GDPbetaS to the pipette medium but not by pertussis toxin. If a cell is dialyzed with medium containing G alpha(s)-GDP, the inhibitory effect is reduced and cannot be recovered by the addition of GTPgammaS, indicating that the alpha(s) is not involved, but rather the betagamma-subunit. Indeed, DA-induced inhibition was mimicked by G betagamma in the pipette and 8-Br-cAMP in the bath. Similarly, G betagamma release from the activation of the AT1 receptor of angiotensin II did affect the current amplitude only in the presence of 8-Br-cAMP in the bath. The mitogen-activated protein kinase cascade, which can be activated by receptors coupled to Gs, was not involved as shown by the lack of activation of p42mapk by DA and the absence of effect of the mitogen-activated protein kinase inhibitor, PD 098059, on the DA-induced inhibition. Because the binding of G betagamma-subunits to various effectors involves the motif QXXER, we therefore tested the effect of the QEHA peptide on the inhibition of the T-type Ca2+ current induced by DA. The peptide, added to the medium pipette (200 microM), abolished the effect of DA. We conclude that the presence of the G betagamma and an increase in cAMP concentration are both required to inhibit the T-type Ca2+ current in rat adrenal glomerulosa cells.
Adenylyl Cyclases↗
[Effects of different doses of edrophonium antagonism of mivacurium-induced neuromuscular block in the presence of nitrous oxide, propofol, and alfentanil anesthesia].
PURPOSE: The purpose of this study was to determine the dose-response relationships for edrophonium antagonism of mivacurium-induced neuromuscular block. METHOD: Seventy-five ASA physical status I or II adults were given mivacurium 0.15 mg.kg-1 followed by an infusion (7 micrograms.kg-1.min-1) during alfentanil-propofol-N2O anaesthesia. Train-of-four stimulation (TOF) was applied to the ulnar nerve every 20 sec and the response of the adductor digiti minimi was recorded (Relaxograph NMT-100, DATEX, Helsinki, Finland). Mivacurium infusion was adjusted at five minutes intervals in order to keep the height of the first twitch in TOF (T1) at 5% of its control value. At the end of surgery, the mivacurium infusion was stopped and edrophonium 0.0, 0.05, 0.1, 0.5 or 1.0 mg.kg-1 combined respectively with glycopyrrolate 0.0, 0.0005, 0.001, 0.005 or 0.01 mg.kg-1 were administered by random allocation. RESULTS: All four edrophonium doses tested were statistically different from placebo with regard to time to attain a TOF ratio (fourth twitch in TOF/T1) = 0.7 (0.05:780 +/- 179, 0.1:727 +/- 216, 0.5:547 +/- 287 and 1.0:640 +/- 236 vs 0.0 mg.kg-1:1089 +/- 323 sec P < 0.05). Does of 0.1, 0.5 and 1.0 mg.kg-1 permitted faster recovery time of T1 from 10 to 95% (T10-95) (567 +/- 236, 419 +/- 166, 555 +/- 288 vs 861 +/- 224 sec P < 0.05) and from 25 to 75% (T25-75) (253 +/- 121, 147 +/- 92, 217 +/- 175 vs 429 +/- 154 sec P < 0.05) than did placebo. However, data showed considerable variability for all neuromuscular indices, no matter the dose of edrophonium used. CONCLUSION: Edrophonium in doses of 0.1 mg.kg-1 and higher permitted faster recovery of all indices from a mivacurium-induced block during alfentanil-propofol-N2O anaesthesia than did placebo.
Adult↗
[Evaluation of the activity of a postoperative analgesia department in a Canadian hospital].
OBJECTIVE: To describe the setting up and the activity of an acute pain service (APS). STUDY DESIGN: Retrospective descriptive study including two surveys among the nursing staff, the first one eight months after the setting up of the APS and the second one ten months later. RESULTS: In the first 19 months, 3,404 patients were treated in the APS: 1,456 with patient-controlled analgesia (PCA), 1,299 with epidural analgesia, 589 with spinal opioids and 60 with continuous nerve blocks. The resulting overall incidence of respiratory depression was 0.7%. It ranged from 0% with continuous nerve block to 1.2% with PCA. It was at 0.3% with epidural analgesia and 0.5% with spinal opioids. Both surveys confirmed that nurses had a positive attitude toward the APS, mainly because they believed it offered patients significant advantages. Many of them thought that epidural analgesia and PCA were likely to impede patient's ambulation and most of them agreed that these techniques increased their work load. CONCLUSION: Although the incidence of respiratory depression was low among the APS patients, it can probably still be decreased by a more refined patient selection. Setting up an APS is viewed positively by the nursing staff in spite of some perceived disadvantages.
Analgesia↗
Dose-response relationships for edrophonium antagonism of mivacurium-induced neuromuscular block during N2O-enflurane-alfentanil anaesthesia.
The purpose of this study was to determine the dose-response relationships for edrophonium antagonism of mivacurium-induced neuromuscular block. Seventy-five ASA I or II adults were given mivarcurium 0.15 mg x kg(-1) followed by an infusion (7 micrograms x kg(-1) x min(-1) during alfentanil-propofol-N2O-enflurane anaesthesia. Train-of-four stimulation (TOF) was applied to the ulnar nerve every 20 sec and the response of the adductor policis was recorded (Relaxograph NMT-100, Datex, Helsinki, Finland). Mivacurium infusion was modified at five-minute intervals in order to keep the height of the first twitch in TOF(T1) at 5% of its control value. At the end of surgery, edrophonium (0.0, 0.125, 0.25, 0.5, or 1.0 mg x kg(-1) combined glycopyrrolate (0.0, 0.0012, 0.0025, 0.005, or 0.01 mg x kg(-1) were administered by random allocation. Edrophonium doses of 0.25, 0.5 and 1.0 mg x kg(-1) were different from placebo with regard to time to attain a TOF ratio (fourth twitch in TOF/T1) = 0.7 (13.8 +/- 4.5, 11.1 +/- 3.5, 11.4 +/- 3.0 vs 19.7 +/- 4.7 min P< 0.05). Doses of 0.5 and 1.0 mg x kg(-1) permitted faster recovery time of T1 from 10 to 95% (T10-95) than did placebo (7.5 +/- 3.8, 8.9 +/- 3.5 vs 14.5 +/- 5.0 min P<0.05). Edrophonium 0.5 mg x kg(-1) was different from placebo with regard to recovery time of T1 from 25 to 75% (T25-75) (3.3 +/- 2.0 vs 6.7 +/- 2.0 min P<0.05). Only edrophonium 0.5 mg x kg(-1) provided faster recovery than placebo with regard to all three indices. It is concluded that edrophonium 0.5 + glycopyrrolate 0.005 mg x kg(-1) allow the fastest recovery from a mivacurium-induced block during enflurane-N2O anaesthesia.
Adolescent↗