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P Rautoma

Publications and source records attributed to P Rautoma.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of airway management with the intubating laryngeal mask, laryngeal tube and CobraPLA by paramedical students in anaesthetized patients.

BACKGROUND: Because of the importance of airway management in emergency care, alternative methods with shorter learning curves for inexperienced personnel have been looked for as a substitute for endotracheal intubation (ETI). METHODS: We compared the success of insertion, oxygenation and ventilation of the intubating laryngeal mask (ILMA), laryngeal tube (LT) and CobraPLA (COB) in anaesthetized patients when used by paramedical students. After informed consent, 96 patients were monitored and anaesthetized for general surgery without the use of a muscle relaxant. After the induction of anaesthesia, 32 paramedical students inserted the ILMA, LT or COB in a random order and ventilated the patient for a 60-s period. The number of insertion attempts, the time needed for insertion, and oxygenation and ventilation parameters were recorded. The students gave a subjective evaluation of the airway devices after the test. RESULTS: Twenty-four of the 32 students (75%) successfully inserted ILMA at the first attempt, compared with 14 of 32 (44%) for LT and seven of 32 (22%) for COB (P<0.001, ILMA vs. COB). One student failed to insert ILMA after all three attempts, compared with seven of 32 (21%) using LT and seven of 32 (21%) using COB (P=not significant). Oxygenation and ventilation parameters did not differ between the groups after successful insertion. CONCLUSION: Clinically inexperienced paramedical students can successfully use ILMA in anaesthetized patients. Further investigations are warranted to study whether ILMA or LT can replace ETI in emergency airway management when used by inexperienced medical or paramedical staff.

Anesthesia, General↗
PubMed2004

Comparison of 27-gauge (0.41-mm) Whitacre and Quincke spinal needles with respect to post-dural puncture headache and non-dural puncture headache.

BACKGROUND: The incidence of headache after spinal anaesthesia has varied greatly between studies. We compared the incidence of postoperative headache in general and postdural puncture headache (PDPH) when using 27-gauge (G) (outer diameter 0.41 mm) Quincke and Whitacre spinal needles in ambulatory surgery performed under spinal anaesthesia. METHODS: In a prospective, randomized study, 676 ASA physical status I-II day-case outpatients were given a spinal anaesthetic through either a 27-G (0.41 mm) Quincke or a 27-G (0.41 mm) Whitacre spinal needle. The incidence of any type of postoperative headache was assessed and the type of headache defined using a standardized questionnaire including PDPH criteria. The severity of the headache was defined using a 100-mm visual analogue scale. RESULTS: For the final analysis, 529 patients were available (259 patients in the Quincke group and 270 patients in the Whitacre group). The overall incidence of postoperative headache was 20.0%, but the incidence of true PDPH was very low (1.51%). The incidence of PDPH in the Quincke group was 2.70%, while in the Whitacre group it was only 0.37% (P < 0.05). The overall incidence of non-dural puncture headache was 18.5% and did not differ between the study groups. CONCLUSIONS: True PDPH seldom occurs when a 27-G (0.41 mm) spinal needle is used, although postoperatively a non-specific headache is common. Using the 27-G (0.41 mm) Whitacre spinal needle further reduced the incidence of PDPH. Thus, we recommend routine use of the 27-G (0.41 mm) Whitacre spinal needle when performing spinal anaesthesia.

Adult↗
PubMed2002

Peroral tramadol premedication increases postoperative nausea and delays home-readiness in day-case knee arthroscopy patients.

BACKGROUND AND AIMS: To evaluate the effect of preoperative oral tramadol on postoperative pain and its effect on the patient's home-readiness after diagnostic day-case knee arthroscopy performed under spinal anaesthesia. MATERIAL AND METHODS: We studied 156 outpatients in a prospective, randomized, double-blind fashion to examine the postoperative analgesic effect of preoperative oral slow-release tramadol. Postoperative pain was measured using a 100-mm visual analogue scale (VAS). Postoperative nausea and vomiting (PONV) and the patients home-readiness were assessed. RESULTS: There were no statistically significant differences in the postoperative VAS scores between the tramadol and placebo groups, nor was there any significant difference in the need for postoperative pain medication. Patients in the tramadol group had higher incidence of PONV and they were discharged from hospital later than those given placebo although the tramadol patients required less intravenous midazolam for sedation. CONCLUSIONS: Preoperatively given slow-release tramadol is ineffective for reduction of postoperative pain after day-case arthroscopy of the knee. Additionally, preoperative tramadol is associated with higher incidence of PONV and it seems to cause delay in the patient's home-readiness.

Adult↗
PubMed2001

Intra-articular ropivacaine injection does not alleviate pain after day-case knee arthroscopy performed under spinal anaesthesia.

BACKGROUND AND AIMS: To evaluate the effect of intra-articular ropivacaine injection on postoperative knee pain after day case arthroscopy. MATERIAL AND METHODS: We studied one hundred outpatients in a prospective, randomized, double-blind fashion to examine the postoperative analgesic effect of intra-articular ropivacaine or saline injected into the knee joint after day-case knee arthroscopy performed under spinal anaesthesia. Patients were interviewed postoperatively with a standardized questionnaire. The postoperative pain was measured using a 100-mm visual analogue scale (VAS). RESULTS: There were no statistically significant differences in the VAS scores of knee pain eight hours or more after the operation between the intra-articular ropivacaine and saline groups, and there was no significant difference in the need for postoperative pain killer. CONCLUSIONS: This study failed to demonstrate a decrease in postoperative VAS scores at eight hours and later postoperatively when 20 ml of ropivacaine 0.5% were injected intra-articularly after day-case knee arthroscopy performed under spinal anaesthesia. Furthermore, there was no significant difference in the need for postoperative pain medication between the study groups.

Adolescent↗
PubMed2000

Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy.

PURPOSE: To compare the postoperative analgesic effects of 50 mg diclofenac p.o. before surgery and intra-articular ropivacaine injected after diagnostic day-case knee arthroscopy performed under spinal anesthesia. METHODS: In a randomized, double-blind investigation, 200 ASA physical status 1-2 outpatients, age 18-60 yr, received either 50 mg diclofenac p.o. or placebo one hour before operation (100 patients per group), and intraarticular injections of either 20 ml of ropivacaine 0.5% or 20 ml of saline 0.9% (50 patients in each premedication groups). Patients received 50 mg diclofenac p.o. prn and, if needed, 0.1 mg x kg(-1) oxycodone im for postoperative pain relief. Patients were discharged home with a supply of 50 mg diclofenac tablets and were given a sheet of paper with knee pain VAS scales and a questionnaire of analgesics taken. Patients rated their VAS scores eight hours after surgery and in the moming and at the end of the first and the second postoperative days, respectively. RESULTS: The only statistically significant difference was found when the diclofenac groups were combined and compared with the combined placebo premedication groups. The VAS scores of knee pain at eight hours after the operation were 19+/-22 in the two diclofenac premedication groups and 32+/-28 in the two placebo groups (P = 0.001). CONCLUSIONS: Diclofenac premedication p.o. reduced the VAS scores at eight hours postoperatively while intra-articular ropivacaine did not.

Administration, Oral↗
PubMed1998

Smoking increases the requirement for rocuronium.

PURPOSE: To compare the potency of rocuronium in non-smokers and smokers during general anaesthesia. METHODS: In a randomized, open clinical study, 40 patients, 17-62 yr of age, were anaesthetized with propofol, alfentanil and nitrous oxide in oxygen. After obtaining individual dose-response curves for rocuronium, bolus doses of rocuronium were given to maintain neuromuscular block at 90-99% for 60 min. Evoked adductor pollicis electromyography (EMG) was used to monitor neuromuscular block. RESULTS: The ED95 values (+/- SEM) for rocuronium were 460.5 +/- 28.9 and 471.5 +/- 22.1 micrograms.kg-1 for non-smokers and smokers, respectively (P:NS). However, doses of rocuronium to maintain 90-99% neuromuscular block (+/- SEM) were 620.1 +/- 46.7 and 747.4 +/- 56.0 micrograms.kg-1.hr-1 for non-smokers and smokers, respectively (P = 0.0504). CONCLUSION: The results may indicate increased metabolism of rocuronium in smokers rather than increased requirement of rocuronium at the receptor site.

Adolescent↗
PubMed1998

Potency and hourly maintenance requirement of combinations of mivacurium and pancuronium in adults.

PURPOSE: To evaluate the dose-response and maintenance requirements of a combination of mivacurium and pancuronium (cMP) in clinical practice. METHODS: In a randomised, open clinical study, 70 patients, 17-50 yr of age, were anaesthetised with propofol, alfentanil and nitrous oxide in oxygen. Thirty patients received mivacurium and 20 patients received pancuronium to establish dose-response curves for these agents. Hourly maintenance requirements of mivacurium and pancuronium to maintain 90-95% neuromuscular blockade (NMB) were determined. Thereafter, 20 additional patients received cMP in incremental doses to establish a cumulative dose-response curve for cMP followed by maintenance doses of cMP. NMB was recorded by adductor pollicis electromyography. RESULTS: The ED95 values for mivacurium and pancuronium were 100 and 66 micrograms.kg-1, respectively; and for the cMP 2:1 (in mg:mg basis), 32 micrograms.kg-1 mivacurium together with 16 micrograms.kg-1 pancuronium. This cMP was 1.8 times more potent than one parent agent (P < 0.0001). When cMP 2:1 was used, 60% of normal maintenance requirement of pancuronium reduced the requirement of mivacurium by > 90%. If cMP 20:1 was used, then 20% of normal maintenance requirement of pancuronium reduced the requirement of mivacurium by > 70%. Neostigmine 35 micrograms.kg-1 given at T1 10% recovery following cMP reversed the NMB to a TOF ratio of 0.70 in 9.5 +/- 3.9 min. CONCLUSION: These results reflect considerable synergism between mivacurium and pancuronium. The cMP is near intermediate-acting and the NMB is easily reversed with neostigmine. By using cMP, it may be possible to save some pharmacological costs during maintenance of anaesthesia.

Adolescent↗
PubMed1998

The pharmacodynamics of mivacurium preceded by atracurium or cisatracurium in children.

UNLABELLED: We evaluated whether mivacurium maintains its short duration of effect when preceded by atracurium or cisatracurium in 45 children during propofol/alfentanil/N2O/O2 anesthesia. Neuromuscular response was recorded by using an adductor pollicis electromyogram (EMG). Children were randomized to receive two doses of atracurium (350 micrograms/kg and 70 micrograms/kg in Group AM), cisatracurium (64 micrograms/kg and 10 micrograms/kg in Group CM), or mivacurium (200 micrograms/kg and 100 micrograms/kg in Group MM), followed by a final dose of mivacurium 100 micrograms/kg. The second and third doses of the muscle relaxants were administered at 25% EMG recovery. After the final dose of mivacurium, the times to 95% of EMG recovery in groups AM, CM, and MM were (median with 10-90 percentile range) 33.0 (28.0-40.0) min, 30.7 (26.0-40.3) min, and 10.3 (8.0-14.0) min, respectively (P < 0.0001). The recovery times to a train-of-four ratio of 0.70 were 30.3 (24.7-37.0) min, 28.0 (24.7-37.7) min, and 10.3 (8.0-13.7) min for groups AM, CM, and MM, respectively (P < 0.0001). Thus, the duration of effect of mivacurium was prolonged by 200% if preceded by either atracurium or cisatracurium. IMPLICATIONS: We compared the pharmacodynamics of mivacurium given alone or preceded by atracurium or cisatracurium in children. The duration of effects of mivacurium was prolonged by 200% if preceded by either atracurium or cisatracurium. This implies that mivacurium has a short duration of effect only when given as a single relaxant.

Adolescent↗
PubMed1996

Effect of smoking on dose requirements for vecuronium.

We have compared the potency of vecuronium given to 12 smokers and 12 non-smokers during propofol-alfentanil-nitrous oxide anaesthesia. After obtaining individual dose-response curves, bolus doses of vecuronium were given to maintain neuromuscular block at 90-98% for 60 min. Adductor pollicis EMG was used to monitor neuromuscular block. Mean ED95 values were 61.38 micrograms kg-1 and 47.49 micrograms kg-1 for smokers and non-smokers, respectively (P < 0.01). The dose of vecuronium to maintain 90-98% neuromuscular block was 25% higher in smokers than in non-smokers (96.80 vs 72.11 micrograms kg-1 h-1; P < 0.01). These data reflect the effects of smoking on neuromuscular block induced by vecuronium. The effect may be at the receptor level, although possible increased metabolism of vecuronium in smokers cannot be excluded.

Adult↗
PubMed1996

Mivacurium when preceded by pancuronium becomes a long-acting muscle relaxant.

BACKGROUND: To ensure rapid recovery of neuromuscular block, it might be useful to administer a short-acting relaxant after a long-acting one. Therefore, the interaction between pancuronium and mivacurium was investigated when mivacurium was administered during the recovery from pancuronium block. METHODS: After written informed consent, 41 adult patients were studied during propofol/alfentanil/nitrous oxide/oxygen anesthesia. Neuromuscular function was monitored using an electromyographic (EMG) method. AFter a stable EMG calibration response, cumulative doses of pancuronium were given to establish a 95% neuromuscular block. In the control group, and ED95 dose of 100 microg/kg mivacurium was administered instead of pancuronium. When the EMG response after pancuronium or mivacurium had recovered to 25% of the baseline, a single randomized intravenous bolus dose of 10 or 70 microg/kg mivacurium was given. Thereafter, spontaneous recovery of the neuromuscular function was recorded. RESULTS: The time from pancuronium until T1 25% EMG recovery was 38 +/- 12 min (mean +/- SD). The respective times after 10 or 70 microg/kg mivacurium were 28 +/- 8 and 54 +/- 7 min in the pancuronium group or 3 +/- 1 (n=3) and 10 +/- 4 min in the mivacurium group (P=0.0001). Times to 95% EMG recovery after 10 or 70 microgm/kg mivacurium were 77 +/- 14 and 97 +/- 16 min in the pancuronium group and 11 +/- 3 and 20 +/- 7 min in the mivacurium group, respectively (P<0.0001). Recovery indexes after 10 or 70 microg/kg mivacurium group, respectively (P<0.0001). Recovery indexes after 10 or 70 microg/kg mivacurium wre 26 +/- 4 and 22 +/- 6 min in the pancuronium group or 7 +/- 3 (n=3) and 5+/- 2 min in the mivacurium group, respectively (P<0.0001). Times from the administration of 10 or 70 microg/kg mivacurium until train-of-four ration 0.7 were 94 +/- 16 and 111 +/- 14 min in the pancuronium group and 12 +/- 4 and 22 +/- 8 min in the mivacurium group, respectively (P<0.0001). CONCLUSIONS: After pancuronium, mivacurium is not a short acting neuromusclar blocking agent.

Adult↗
PubMed1996

Rocuronium in infants, children and adults during balanced anaesthesia.

We studied 20 infants, 20 children and 20 adults during balanced anaesthesia to compare the neuromuscular blocking effects of rocuronium in these age groups. Neuromuscular function was recorded by adductor pollicis emg and a cumulative log-probit dose-response curve of rocuronium was established. Thereafter, full spontaneous recovery of the neuromuscular function was recorded. Onset time of the first dose of rocuronium was shorter in children than in infants or adults. The potency of rocuronium was greatest in infants and least in children; the ED50 doses (mean +/- SD) being 149 +/- 36 micrograms.kg-1 in infants, 205 +/- 52 micrograms.kg-1 in children and 169 +/- 47 micrograms.kg-1 in adults (P < 0.05 between infants and children) and the ED95 doses being 251 +/- 73 micrograms.kg-1, 409 +/- 71 micrograms.kg-1 and 350 +/- 77 micrograms.kg-1, respectively (P < 0.05 between all groups). The emg recovery following an average 94.5 +/- 4.8% neuromuscular blockade established by rocuronium was roughly similar in all study groups. Thus, one ED95 dose of rocuronium, unlike vecuronium, acts as an intermediate-acting agent in all age groups.

Adult↗
PubMed1995

Interaction between mivacurium and succinylcholine.

We investigated the interaction between mivacurium and succinylcholine when mivacurium was administered during the early recovery from succinylcholine block. We studied 40 adult patients during propofol-alfentanil-N2O-O2 anesthesia. Neuromuscular function was monitored using an electromyographic method (Relaxograph, Datex, Helsinki, Finland). Patients randomly received either 1.0 mg/kg of succinyl-choline followed by 0.15 mg/kg of mivacurium when the first twitch (T1) during succinylcholine block recovered to 5%, or 0.15 mg/kg of mivacurium without succinylcholine. Serum cholinesterase activity was lower than normal range in two patients and higher than normal range in four patients, but the dibucaine number value was normal in every patient. The mean onset time (3.8 +/- 0.9 min) (mean +/- SD) or maximal neuromuscular block (96.6% +/- 7.2%) of mivacurium did not differ between the groups. The T1 recovery times of mivacurium were slightly shorter (P < 0.05) after succinylcholine administration than without it. During recovery of mivacurium block, the fade was significantly greater, i.e., the train-of-four (TOF) ratio was lower, after succinylcholine administration than without it. Recovery index (T1 25%-75%, mean 4.7 +/- 1.3 min) and the time from the administration of mivacurium to the recovery of TOF ratio 0.7 (mean 20.4 +/- 5.1 min) were not different between the groups. In conclusion, in healthy patients succinylcholine has negligible effects on a subsequent mivacurium-induced neuromuscular block.

Adolescent↗
PubMed1995

Potency and maintenance requirement of atracurium and vecuronium given alone or together.

A synergism exists between some competitive muscle relaxants. However, maintenance requirement of a combination of muscle relaxants has been evaluated only in paediatric patients. We studied 45 elective adult surgical patients (ASA I-II) during propofol-alfentanyl-N2O-O2-anaesthesia. The first 30 patients were randomized to receive either atracurium or vecuronium to create individual dose-response curves for these muscle relaxants. ED95-values for atracurium and vecuronium were 260 +/- 9 and 59 +/- 3 micrograms.kg-1, respectively (mean +/- s.e. mean). Requirements of atracurium and vecuronium to maintain an 85-95% neuromuscular blockade were 301 and 83 micrograms kg-1 h-1, respectively. An additional 15 patients received a combination of atracurium and vecuronium (cAV) in an equipotent dose ratio. An ED95 of a cAV was 94 +/- 7 micrograms.kg-1 of atracurium together with 21 +/- 2 micrograms.kg-1 of vecuronium, or 72 +/- 6% of one ED95 dose of a parent agent. Potentiation was significant (P = 0.0001). A maintenance requirement of a cAV was 120 micrograms kg-1 h-1 of atracurium together with 27 micrograms kg-1 h-1 of vecuronium. Thus, a significant potentiation was maintained also during the course of anaesthesia. A cAV had an effect like one intermediate-acting agent. If a cAV is used instead of using atracurium or vecuronium alone, the maximal reduction of drug consumption would be approximately 30%.

Adolescent↗
PubMed1995

Synergism between mivacurium and pancuronium in adults.

Mivacurium could be a useful agent as a final dose of a muscle relaxant following pancuronium if only additivity exists between these agents. We examined the interaction between mivacurium and pancuronium in 70 patients (ASA I-II) during propofol-alfentanil-N2O-O2 anaesthesia. Neuromuscular function was monitored by adductor pollicis EMG. Firstly we established dose-response curves for mivacurium and pancuronium. Thereafter, 20 patients received a combination of 0.5 times the ED50 doses of mivacurium and pancuronium (cMP) determined in the first part of this study. Patients were randomized to receive the cMP to the same IV-line (n = 10) or to two separate IV-lines in opposite hands (n = 10). ED50 values for mivacurium and pancuronium were 57.7 and 37.1 micrograms kg-1, respectively. Maximal neuromuscular block following the cMP was 91.8 +/- 5.0% (mean +/- SD). This was highly significantly different from the estimated 50% NMB if only additivity exists between mivacurium and pancuronium (P = 0.0001). After the cMP, the 25-75% recovery time was 9.4 +/- 1.3 min and the time to train-of-four ratio of 0.70 was 35.8 +/- 5.4 min. There was no statistical difference in any recorded neuromuscular parameter between the two subgroups receiving mivacurium and pancuronium to the same or to opposite hands (P > 0.40). We conclude that a significant synergism exists between mivacurium and pancuronium which may indicate that mivacurium does not produce a short-acting NMB if given after pancuronium. We do not recommend using mivacurium together with pancuronium.

Adolescent↗
PubMed1995

The duration of action of mivacurium is prolonged if preceded by atracurium or vecuronium.

We studied 45 patients (ASA I-II) during propofol-alfentanil-N2O-O2 anaesthesia to determine if recovery from neuromuscular block induced by mivacurium is influenced differently by prior injection of atracurium or vecuronium. Neuromuscular function was monitored by adductor pollicis EMG. Patients were randomized to receive two doses of either mivacurium (150 and 70 micrograms kg-1), atracurium (350 and 75 micrograms kg-1) or vecuronium (70 and 15 micrograms kg-1) followed by a final dose of mivacurium 70 micrograms kg-1. The second and third doses of the muscle relaxants were administered at 25-30% recovery of the E1 (first EMG response in the train-of-four series). Following the final dose of mivacurium, the EMG response recovered to 25 and 95% in 10.4 +/- 3.9 and 19.7 +/- 5.7 min (mean +/- SD), respectively, if mivacurium was the only muscle relaxant. Respective times were 100% longer if mivacurium had been preceded by atracurium (23.8 +/- 3.3 and 39.8 +/- 6.9) or vecuronium (22.6 +/- 3.5 and 44.1 +/- 7.9 min) (P = 0.0001). The 25-75% recovery times in the three groups were 4.9 +/- 1.0, 8.7 +/- 2.4 and 10.5 +/ 2.5 min, respectively (P = 0.0001). Our results indicate that there is no benefit in giving mivacurium at the end of surgery after peroperative use of atracurium or vecuronium.

Adolescent↗
PubMed1995

Dose-response and time-course of effect of rocuronium bromide in paediatric patients.

We determined dose-response curves and spontaneous recovery of neuromuscular function following a single ED95 dose of rocuronium in 10 infants (1-11 months old), 20 children (2-12 years old) and 20 adults (20-40 years old) during nitrous oxide-oxygen-thiopentone-alfentanil anaesthesia. Neuromuscular block was recorded as adductor pollicis EMG following a supramaximal train-of-four ulnar nerve stimuli at 10 s intervals. ED95 values were significantly less for infants than for children or adults (255 +/- 62, 402 +/- 68 and 350 +/- 78 micrograms kg-1, respectively, P = 0.0001). Time-course of recovery from an average 94% neuromuscular block was similar in all age groups with a 25-75% recovery time of 6.5 +/- 1.8, 5.7 +/- 1.8 and 6.7 +/- 1.6 min in infants, children and adults, respectively. Thus, rocuronium is an intermediate-acting muscle relaxant in all age groups.

Adult↗