PubMed · 8214488
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J P Fee. 1993. Getting back to normal.. https://doi.org/10.1111/j.1365-2044.1993.tb07580.x
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STUDY OBJECTIVE: To determine the neuromuscular blocking effect and recovery profile of cisatracurium besylate in children after administration of a bolus dose that was twice the estimated dose required to produce 95% of the maximum effect (2 x ED95; 0.08 mg/kg) followed by an infusion during halothane-nitrous oxide anesthesia. STUDY DESIGN: Open-label study. SETTING: Teaching hospital. PATIENTS: 30 male and female (ASA physical status I and II) patients, 2 to 10 years of age, scheduled for elective surgery of low to moderate risk. INTERVENTIONS: After induction of general anesthesia, patients received cisatracurium 0.08 mg/kg administered over 5 to 10 seconds. For surgical procedures requiring neuromuscular block for at least 60 minutes, a second bolus dose of cisatracurium 0.02 mg/kg was administered after the first response to a train-of-four stimuli (T1) recovered to 25% of baseline. When T1 was 5% of baseline after the second dose, a 3 microg/kg/min infusion of cisatracurium was initiated and titrated to maintain 89% to 99% block for the duration of the surgery. For procedures requiring neuromuscular block of less than 60 minutes, one or more maintenance doses of 0.02 mg/kg cisatracurium were administered when T1 was 25% of baseline after the preceding dose. In 10 patients, recovery was facilitated with edrophonium 1.0 mg/kg administered when T1 was 26% to 48% of the final baseline. MEASUREMENTS AND MAIN RESULTS: Evoked muscular response at the adductor pollicis was measured by electromyography. With 0.08 mg/kg, onset time (mean +/- SEM) was 4.1 +/- 0.4 minutes, and clinically effective duration was 27.3 +/- 0.9 minutes. Mean 5% to 95% and 25% to 75% recovery indices were 28.4 +/- 2. 7 minutes and 11.2 +/- 0.8 minutes, respectively. The mean infusion rate necessary to maintain 89% to 99% T1 suppression for 17 to 145 minutes was 1.7 microg/kg/min. After termination of infusion, the mean 5% to 95% and 25% to 75% recovery indices were similar to those after a single bolus dose, and time to 95% recovery was 30.4 +/- 3.0 minutes. After administration of edrophonium, full recovery (T4:T1 > or = 70%) occurred in 1.5 +/- 0.4 minutes. No clinically significant changes in heart rate or blood pressure were noted during the first 5 minutes after administration of cisatracurium 0.08 mg/kg. CONCLUSIONS: Cisatracurium provided maximal neuromuscular block, cardiovascular stability, and predictable recovery at the doses tested. In view of this finding, cisatracurium should be a useful intermediate-duration neuromuscular blocking drug for children during general anesthesia.
Hypoxemia has long been recognized as a risk to patients in the operating room and postanesthesia care unit, and hemoglobin oxygen saturation (HbO2) monitoring with pulse oximetry has become a standard of care in these areas. There is growing evidence, however, suggesting that later postoperative hypoxemia also may play a role in organ dysfunction leading to morbidity and mortality. Economic pressures to move patients earlier from expensive postanesthesia recovery and intensive care areas to the general care floor -- where nurse-to-patient ratios are lower and lines of sight and sound may be impaired by walls and curtains -- may lead to inadequate surveillance of at-risk patients. These patient-management trends underscore the importance of improved monitoring of respiratory status on the general care floor. In this environment, telemetric pulse oximetry monitoring may represent a cost-effective approach to maximizing quality of care while enhancing risk management. This review discusses late postoperative hypoxemia and identifies areas for further investigation.
The physical compatibility of thiopentone and propofol mixtures was investigated. The investigations used were macroscopic and microscopic observations, zeta potential and oil droplet size measurements. There was no evidence of instability in the mixtures. The thiopentone-propofol mixture has the potential advantage of reducing the pain on injection, provides synergistic interaction, does not prolong recovery when used for induction of anaesthesia, may reduce the incidence of convulsions and is cost-effective.