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PubMed1999

Lightwand intubation does not reduce the increase in intraocular pressure associated with tracheal intubation.

OBJECTIVE: To evaluate the changes in hemodynamic variables and intraocular pressure (IOP) after tracheal intubation using either lightwand or direct-vision laryngoscopy techniques. DESIGN: Prospective, randomized study. SETTING: Inpatient anesthesia at a University Anesthesia Department. PATIENTS: 50 normotensive, ASA physical status I and II patients, without ocular or cardiovascular diseases, and with a Mallampati score no greater than 2. INTERVENTIONS: After intravenous (i.v.) midazolam premedication (0.05 mg.kg-1), general anesthesia was induced with fentanyl (1 microgram.g-1) and thiopental sodium (5 mg.g-1) followed by vecuronium bromide (0.1 mg.g-1), then patients were randomly allocated to receive either the lightwand (Trachlight, n = 25) or direct-vision laryngoscopy (Laryngoscopy, n = 25) intubating techniques. General anesthesia was maintained with 1% isoflurane and 60% nitrous oxide in oxygen mixture for 5 minutes. MEASUREMENTS AND MAIN RESULTS: Baseline hemodynamic variables were recorded 10 minutes after i.v. premedication, and then every minute after tracheal intubation. Intraocular pressure measurements were performed by means of a computerized indentation tonometer after general anesthesia induction and then 1 and 5 minutes after tracheal intubation. In both groups, mean arterial blood pressure and heart rate increased from baseline, without differences between the two groups. One minute after intubation, IOP increased in both groups: the mean percentage increase was 32% in the Laryngoscopy group and 16% in the Trachlight group. However, this difference was not statistically significant. Five minutes after intubation, IOP decreased to baseline values in both groups. CONCLUSION: We conclude that in healthy patients without ocular disease, using a lightwand intubating technique does not reduce the hemodynamic responses and increase in IOP associated with tracheal intubation as compared with conventional direct-vision laryngoscopy.

Anesthesia, General↗
PubMed1990

Risk factors for hydrocortisone myopathy in acute severe asthma.

In one hospital over a 15-month period, four out of nine patients ventilated for acute severe asthma developed acute hydrocortisone myopathy. All patients had received less than 1.0 g day-1 hydrocortisone. Affected patients had severe generalized weakness which recovered over 1-6 weeks. When myopathic and unaffected subjects were compared, there was no clearcut difference with respect to age, sex, types of drug used, serum potassium levels, duration of ventilation and muscle paralysis, total dose of vecuronium bromide, or mean daily doses of hydrocortisone. The main difference between the two groups was in the total doses of hydrocortisone. The myopathic patients all received greater than 5.0 g hydrocortisone (range 5.4-10.2 g) and the others less than 4.0 g (range 0.9-3.5 g). The possibility that neuromuscular blockade might predispose to the development of myopathy is discussed. Hydrocortisone myopathy can occur when less than 1.0 g day-1 is used, and even with as little as 5.4 g given over 6 days.

Acute Disease↗
PubMed2001

Comparison of genotoxicity of sevoflurane and isoflurane in human lymphocytes studied in vivo using the comet assay.

In the present paper, we report data on the possible genotoxic properties of two inhalation anaesthetics--sevoflurane (SVF) and isoflurane (ISF) - in peripheral blood lymphocytes of patients before, during and after anaesthesia as compared to an unexposed control group. Both anaesthetics were evaluated for genotoxic activity using the comet assay. The exposed groups consisted of 24 ASA grades 1-2 unpremedicated patients (aged 20-66 years, anaesthetized 115-162 min for elective lower abdominal surgery), while the control group consisted of 12 healthy individuals. After induction of anaesthesia (thiopenthone sodium 5-7 mg/kg, fentanyl citrate 0.1mg and vecuronium bromide 0.1mg/kg), anaesthesia was maintained with inhalation of SVF 1-1.5% (n=12) or ISF 1-1.5% (n=12) in oxygen-air mixture. Venous blood samples were obtained before the induction of anaesthesia, at 60 and 120 min of anaesthesia and on the first, third and fifth days following anaesthesia. The comet assay detects DNA damage which includes strand breaks and alkaline labile sites induced directly by genotoxic agents as well as DNA degradation due to cell death. One hundred cells from each sample were examined and graded as no tailed, short and long tailed nuclei. The mean comet response was not different between controls and patients before anaesthesia. However, similar significant increases were observed in the mean comet response in blood sampled from patients at 60 (36.5+/-11.2, 37.8+/-12.1), or 120 min (53.1+/-17.1, 50.0+/-12.2) of anaesthesia and on the first day (37.8+/-15.1, 35.2+/-15.7) after anaesthesia in SVF and ISF treated groups, respectively. Removal of the DNA damage was observed after the third day of anaesthesia and the repair was completed within 5 days. The DNA damage detected in lymphocytes of patients during anaesthesia with SVF or ISF showed similar results as demonstrated by an increased mean comet migration at 120 min of anaesthesia and the cells were able to repair the induced DNA damage completely on the fifth postoperative day.

Adult↗
PubMed2005

Anaesthesia and circulating blood volume.

BACKGROUND AND OBJECTIVE: The exact change in circulating blood volume (BV) during general anaesthesia is still unknown because there is no standard method of evaluating BV. We evaluated the changes in BV by general anaesthesia using simple and easy estimation methods. METHODS: Fourteen patients scheduled for minor surgery under general anaesthesia were enrolled. Propofol and vecuronium bromide were used for the induction of anaesthesia, and anaesthesia was maintained with sevoflurane and nitrous oxide. Haematocrit (Hct), total protein concentration (TP), as well as colloid osmotic pressure (COP) measured using a colloid osmometer, were determined before anaesthesia, and 30, 60 and 90 min after the induction of general anaesthesia. BV was calculated using Allen's formula and the changes in Hct, TP and COP. The estimated BV was compared with directly measured BV using indocyanine green dilution method (BV(ICG)). RESULTS: Hct, TP and COP significantly decreased after the induction of anaesthesia (Hct: 42.1-39.4%; TP: 7.3-6.9 g dL(-1); COP: 23-19 mmHg). The calculated BV as well as BV(ICG) significantly increased after induction of anaesthesia (calculated by COP: 4.13-5.03 L; BV(ICG): 4.54-5.56 L). The change rate in BV calculated by the change of COP was larger than other calculated BVs, and was approximated to the change rate in BV(ICG). After emergence from anaesthesia, all values tended to return to baseline. CONCLUSIONS: General anaesthesia increases BV. The value of BV calculated from the change in COP was most changeable.

Adult↗
PubMed1997

Effect of the inhibitor of NO synthase, NG-nitro-L-arginine methyl ester, on histamine-induced bronchospasm in the rabbit.

New Zealand male rabbits were anaesthetized with thiopental, tracheotomized, curarized by vecuronium bromide and mechanically ventilated. Six rabbits received L-NAME 10 mg kg-1 i.v., six rabbits L-NAME 15 mg kg-1 iv, and six rabbits received saline i.v. (controls), 5 min before a histamine aerosol (2% solution during 5 min). Six others rabbits received an injection of L-NAME 15 mg kg-1 iv, 5 min before the histamine aerosol, followed by an infusion of L-arginine over a 60- min period. Total respiratory resistance (Rrs) and elastance (Ers) were derived by least square analysis of the relationship between tracheal pressure and flow, and computed every minute before and over a 1-h period after the histamine aerosol. Oxygen free radicals (OFR) were measured with a luminometer, in microsomes from lung homogenates at the end of the experiment. Compared with the histamine response of the control group, the Rrs response in the L-NAME 10 group was slightly less, while Ers changes were the same in the two groups. In contrast, L-NAME 15 was responsible for an increased Rrs response, the difference being significant (P < 0.05) only between 15 and 40 min after the aerosol (+114% vs. +85% in controls at the 20th min). The increase in Ers with L-NAME 15 was stronger and significantly larger (+71% vs. +42% in controls at the 20th min after the histamine aerosol, P < 0.001). The relatively greater effect of L-NAME on Ers than on Rrs suggests that NO predominantly modulates the response to histamine of the peripheral lung rather than that of the large airways. Furthermore, the effect of L-NAME on Rrs was completely abolished by L-arginine, while its effect on Ers was only partially reversed. This suggests that the changes in Ers are partly related to a hardly reversible phenomenon. Possibly, the mechanical changes are linked with the rise of OFR in the lung parenchyma, which were significantly higher in the L-NAME 15 group compared to the control group (P < 0.05).

Animals↗
PubMed2001

Inhaled nitric oxide administration during one-lung ventilation in patients undergoing thoracic surgery.

OBJECTIVE: To evaluate the effects of inhaled nitric oxide (iNO) on hemodynamics and oxygenation during one-lung ventilation (OLV) in the lateral decubitus position in patients undergoing elective thoracic surgery. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Thirty consecutive patients scheduled for thoracotomy. INTERVENTIONS: Anesthesia consisted of thoracic epidural analgesia combined with general anesthesia (isoflurane, fentanyl, and vecuronium bromide). Systemic and pulmonary circulations were monitored with a radial artery catheter and a pulmonary artery catheter. Inhaled NO, 40 ppm, was administered during OLV, and the inhaled gas mixture was monitored for NO and nitrogen dioxide (NO2). Hemodynamic and oxygenation data were collected before and during inhaled NO administration. MEASUREMENTS AND MAIN RESULTS: Inhaled NO caused a reduction of pulmonary vascular resistance index from 249 +/- 97.6 dyne. sec. cm(-5) to 199.3 +/- 68.9 dyne. sec. cm(-5) (p < 0.05), without effects on systemic hemodynamics or impairment of oxygenation. A stratification of the patients according to values of QS/QT (< 30%, 30% to 44%, > or = 45%), PaO(2)/fraction of inspired oxygen (> or = 200, 100 to 199, < 100), and pulmonary hypertension (mean pulmonary arterial pressure < 24 or > or = 24 mmHg) showed that inhaled NO causes a significant reduction of mean pulmonary artery pressure in patients with pulmonary hypertension, mainly as a result of a reduction of pulmonary vascular resistance index, and improves oxygenation by reducing intrapulmonary shunt in patients with severe hypoxemia during OLV. CONCLUSIONS: Inhaled NO administration neither significantly decreased mean pulmonary arterial pressure in patients with normal pulmonary artery pressure nor improved oxygenation in nonhypoxic patients. Nevertheless, inhaled NO is effective in patients with pulmonary hypertension and hypoxemia during OLV.

Aged↗
PubMed2003

QT dispersion increases during intubation in patients with coronary artery disease.

Anesthetic drugs have been shown to increase QT interval, however data regarding their effects on QT dispersion (QTd) are scarce, especially in patients with coronary artery disease (CAD). We tested whether induction of Anesthesia with thiopental and etomidate would increase QTd in patients with CAD. Thirty American Society of Anesthesiologists (ASA) physical status I-II patients without CAD were randomly allocated to groups I (n = 15) and II (n = 15) and 30 ASA physical status III patients with CAD were randomly allocated to groups III (n = 15) and IV (n=15). Anesthesia was induced with thiopental 5-7 mg/kg IV in groups I and III and with etomidate 0.2-0.3 mg/kg IV in groups II and IV. Endotracheal intubation was facilitated with vecuronium bromide 0.1 mg/kg IV. Twelve-lead electrocardiogram (ECG) was recorded in all patients at baseline (ECG(1)), 1 min after the induction agent (ECG(2)), 1 min (ECG(3)) and 5 min (ECG(4)) after intubation. Anesthesia was maintained with isoflurane and nitrous oxide in 34 % oxygen after ECG(2) recording. QTd and corrected QT dispersion (QTcd) were calculated. In patients with CAD induced with thiopental, QT dispersion increased significantly during the intubation period compared with baseline (from 43.0 +/- 25.6 ms to 69.2 +/- 25.3 ms; P <.01). Likewise, QT dispersion also increased during intubation in patients with CAD induced with etomidate (from 41.5 +/- 17.2 ms to 80.0 +/- 33.6 ms; P <.001). There was no increase in QT dispersion in patients without known CAD. QT dispersion seems to be increased during the intubation period in patients with CAD regardless of the induction agents used.

Aged↗
PubMed1991

[Perioperative treatment of a patient with myotonic muscular dystrophy (Curschmann-Steinert disease)].

The perioperative period is hazardous for patients with neuromuscular disorder. In case of dystrophia myotonica the anaesthesist must avoid all stimuli that may cause a myotonic crisis. If neuromuscular blockade is required, the moderately long-acting vecuronium bromide seems to be the drug of first choice. Blockade and recovery should be monitored. Postoperative pulmonary complications can be minimised by using regional anaesthetic techniques including epidural anaesthesia with local anaesthetics and/or opioids.

Anesthesia, General↗
PubMed1992

Fentanyl and sufentanil increase intracranial pressure in head trauma patients.

Although opioids frequently are administered to patients with severe head trauma, the effects of such drugs on intracranial pressure are controversial. Nine patients with severe head trauma were studied for the effects of fentanyl and sufentanil on intracranial pressure (ICP). In all patients, ICP monitoring was instituted before the study. Full neuromuscular blockade was achieved with vecuronium bromide before the administration of either fentanyl (3 micrograms.kg-1) or sufentanil (0.6 microgram.kg-1) as an intravenous bolus over a 1-min period in a masked and random fashion. Patients received the other opioid in the same fashion 24 h later. Arterial blood pressure, heart rate, and ICP were recorded continuously for the 1 h after drug administration. Fentanyl was associated with an average ICP increase of 8 +/- 2 mmHg, and sufentanil with an increase of 6 +/- 1 mmHg. These increases were statistically significant. Both drugs produced clinically mild decreases in mean arterial blood pressure (fentanyl, 11 +/- 6 mmHg; sufentanil, 10 +/- 5 mmHg) that nevertheless were statistically significant. No significant changes in heart rate occurred. These results indicate that modest doses of potent opioids can significantly increase ICP in patients with severe head trauma.

Adult↗
PubMed1999

The independent effect of propofol anesthesia on whole body protein metabolism in humans.

BACKGROUND: The purpose of this study was to examine the effect of general anesthesia with propofol in the absence of surgical stimulation on whole body protein metabolism. METHODS: Six unpremedicated patients were studied. General anesthesia included propofol (120 microg x kg(-1) x min(-1)), vecuronium bromide, and oxygen-enriched air. Changes in protein breakdown, protein oxidation, and synthesis were measured by an isotope dilution technique using a constant infusion of the stable isotope tracer L-[1-13C]leucine (0.008 mg x kg(-1) x min(-1)) before and during 100 min of propofol anesthesia. The plasma concentrations of glucose, lactate, non-esterified fatty acids, and cortisol were measured before and during anesthesia. RESULTS: An isotopic steady state of plasma [1-13C]alpha-ketoisocaproate (taken to represent the intracellular leucine precursor pool enrichment for protein synthesis) and expired 13C-carbon dioxide were obtained before and during propofol infusion. Whole body protein breakdown decreased during propofol anesthesia by 6% (P < 0.05), whereas protein synthesis and oxidation did not change significantly. Plasma concentration of cortisol decreased after 90 min of propofol anesthesia (P < 0.05). No significant changes of plasma concentrations of glucose, lactate, and non-esterified fatty acids occurred during propofol administration. CONCLUSIONS: Propofol anesthesia did not significantly affect whole body protein synthesis and oxidation but caused a small, although significant, decrease in whole body protein breakdown, possibly mediated through the suppression of plasma cortisol concentration.

Adult↗
PubMed2000

Oxygen-carrying capacity during 10 hours of hypercapnia in ventilated dogs.

OBJECTIVE: To test if a relatively long-term exogenous hypercapnia, equivalent to those maintained during permissive hypercapnia, can persistently increase oxygen-carrying capacity in ventilated dogs. DESIGN: Prospective study. SETTING: Research laboratory in a hospital. SUBJECTS: Six mongrel dogs (3 males; 3 females). INTERVENTIONS: The dogs were anesthetized (30 mg/kg pentobarbital, i.v.), intubated, and cannulated in one femoral artery, one femoral vein, and the right jugular vein. The mean arterial blood pressure, heart rate, and mean pulmonary artery pressure were continuously recorded. Anesthesia, fluid balance, and normothermia were maintained. Arterial hypercapnia was generated by the addition of 60 torr dry CO2 (8 kPa) to the inspired air for 10 hrs, continuously. All subjects were paralyzed (vecuronium bromide) and ventilated with room air, while the ventilator settings were kept constant. MEASUREMENTS AND MAIN RESULTS: Arterial and venous gas exchange profiles, hemoglobin concentration, oxygen saturation, oxygen content, cardiac output, and oxygen consumption were determined, before, during, and after 10 hrs of hypercapnia, periodically. Both hemoglobin concentration and oxygen content were gradually increased during hypercapnia and reached significant levels at 8 and 10 hrs of hypercapnia, respectively. These increases continued up to 2 hrs after termination of hypercapnia. The PaO2/FIO2, as an index of arterial oxygenation, was significantly increased during the first 3 hrs of hypercapnia and then remained at the normoxic level up to 10 hrs of hypercapnia. No significant changes occurred in the mean arterial blood pressure and oxygen consumption. The heart rate and cardiac output were significantly reduced at 4 and 8 hrs of hypercapnia, respectively. The mean pulmonary artery pressure was increased throughout the hypercapnic trial. CONCLUSIONS: A relatively long-term exogenous hypercapnia can significantly increase oxygen-carrying capacity in normal ventilated dogs. Whether this effect can occur during permissive hypercapnia because of controlled ventilation in patients warrants investigation.

Animals↗
PubMed2001

Effects of arteriovenous extracorporeal therapy on hemodynamic stability, ventilation, and oxygenation in normal lambs.

OBJECTIVE: To evaluate hemodynamic stability and gas exchange in a neonatal animal model of pumpless arteriovenous extracorporeal membrane oxygenation (AV-ECMO) with extracorporeal shunt flow of up to 15% of cardiac output during variable ventilation and oxygenation. DESIGN: Prospective study. SETTING: Research laboratory in a hospital. SUBJECTS: Seven lambs (5.5 +/- 0.6 kg, mean +/- sd). INTERVENTIONS: The lambs initially were anesthetized by 50 mg/kg ketamine intravenously. After tracheostomy, the lambs were mechanically ventilated and paralyzed by using 1 mg/kg vecuronium bromide followed by 0.1 mg.kg(-1).hr(-1). One femoral vein was cannulated with a pulmonary artery flotation catheter and used for cardiac output and pulmonary artery pressure measurements. A femoral artery was cannulated for measuring mean arterial blood pressure, measuring heart rate, and blood sampling for gas exchange analyses. Finally, the right internal jugular vein and carotid artery were cannulated and used for the AV-ECMO. Normothermia (38 +/- 0.5 degrees C), fluid balance (5 mL.kg(-1).hr(-1) normal saline), and anesthesia (5 mg.kg(-1).hr(-1), intravenous ketamine) were maintained. Ventilator settings were adjusted to establish a baseline Paco2 (25-35 mm Hg) at an Fio2 of 0.4. The AV-ECMO circuit was established by using a hollow fiber oxygenator, primed with maternal sheep blood (150-200 mL). MEASUREMENTS AND MAIN RESULTS: The physiologic effects of the AV-ECMO shunt were evaluated at 15, 25, and 40 mL.kg(-1).hr(-1) ECMO flow, corresponding roughly to 4%, 8%, and 15% of the cardiac output values. The baseline minute volume was maintained during stepwise increases in arteriovenous shunt. A significant increase in endogenous cardiac output occurred at arteriovenous shunt of 25 and 40 mL.kg(-1).hr(-1) (analysis of variance followed by Tukey-Kramer multiple comparisons test), which was attributed to a significant increase of 30% in the heart rate. Effective cardiac output (difference between the thermodilution value and the AV-ECMO flow rate) and mean arterial blood pressure were not significantly changed. CO2 removal, measured at 15% arteriovenous shunt, was significantly increased with decreasing ventilation to 25% and 50% of the baseline (analysis of variance and Tukey-Kramer test). Oxygenation through the membrane was measured after reducing inspired Fio2 from 0.4 to 0.21, 0.15, and 0.10 with 15% arteriovenous shunt and baseline minute ventilation. Oxygen delivery by the oxygenator was significantly increased at Fio2 of 0.10, providing a maximum of 19.5% of the total oxygen consumption at an arterial hemoglobin-oxygen saturation of 60%. CONCLUSIONS: Healthy lambs are capable of maintaining effective cardiac output in the presence of moderate arteriovenous shunts (15%). AV-ECMO may provide efficient ventilatory support in the neonatal population with hypercapnia. The amount of oxygen delivery with AV-ECMO depends on arterial desaturation.

Animals↗
PubMed1996

Persistent paralysis after prolonged use of atracurium in the absence of corticosteroids.

Neuromuscular blocking agents (NMBAs) are often used for patients requiring prolonged mechanical ventilation. Reports of persistent paralysis after the discontinuance of these drugs have most often involved aminosteroid-based NMBAs such as vecuronium bromide, especially when used in conjunction with corticosteroids. Atracurium besylate, a short-acting benzylisoquinolinium NMBA that is eliminated independently of renal or hepatic function, has also been associated with persistent paralysis, but only when used with corticosteroids. We report a case of atracurium-related paralysis persisting for approximately 50 hours in a patient who was not treated with corticosteroids.

Adrenal Cortex Hormones↗
PubMed1997

Evaluation of motor function during thoracic and thoracolumbar spinal surgery based on motor-evoked potentials using train spinal stimulation.

STUDY DESIGN: Using compound muscle action potentials after train spinal stimulation, intraoperative motor functional monitoring was performed during thoracic and thoracolumbar spinal surgery. OBJECTIVES: This study was designed to clarify the clinical usefulness of train spinal stimulation and to determine the critical point of compound muscle action potential change at which neurologic injury during surgery occurs. SUMMARY OF BACKGROUND DATA: In 1995 the authors reported that train spinal stimulation allows for the recording of compound muscle action potentials, even in animals and humans under general anesthesia. The facilitative effect of train stimulation overcomes the suppressive effects of anesthetics and allows potentials to pass through synapses, thereby enabling a reliable recording of lower extremity compound muscle action potential. METHODS: Multisegmental recording of compound muscle action potentials after train spinal stimulation was conducted on 34 patients Undergoing surgical treatment for thoracic or thoracolumbar lesions. During surgery, train stimuli (5 pulse, Interstimular Interval: 1 ms) were administered using an epidural electrode introduced transcutaneously. Compound muscle action potentials were recorded from a total of 128 muscles. Anesthesia was maintained using fentanyl and propofol or nitrous oxide with or without isoflurane. Muscle relaxation was attained mainly by controlled infusion of vecuronium bromide. The percent occurrence of recordable compound muscle action potentials was determined, and the potential changes were correlated with changes in muscle strength. RESULTS: Compound muscle action potentials could be recorded from at least one muscle in 94% of the patients, even in most patients with severe motor dysfunction. The compound muscle action potential changes before and after surgical maneuver were divided into four grades. All compound muscle action potential changes in deteriorated muscles belonged to Grade 2 (a 10% latency delay) or Grade 3 (disappearance). CONCLUSIONS: The success rate in obtaining muscle potentials was greatly enhanced when all of the following methods were used: train spinal stimulation, anesthetic with weak suppressive effect, multiple muscle recording, and percutaneous introduction of epidural electrode. The critical point of compound muscle action potential change should be defined as a 10% latency delay or disappearance. Multisegmental muscle potential after train spinal stimulation is the most appropriate method for thoracic and thoracolumbar spinal surgery.

Adult↗
PubMed1987

Recovery from propofol infusion as the main agent for outpatient arthroscopy. A comparison with isoflurane.

Propofol by continuous intravenous infusion has been compared with isoflurane as the main anaesthetic agent for outpatient arthroscopy of the knee. In 40 unpremedicated patients, anaesthesia was induced with propofol 2 mg/kg and vecuronium bromide 0.1 mg/kg and maintained after tracheal intubation with nitrous oxide 66% in oxygen. One group received 3% isoflurane prior to intubation and 0.9% during maintenance, while the other received a continuous intravenous infusion of propofol at a rate of 10 mg/kg/hour. Recovery was assessed by the time to opening eyes, to be able to answer five questions correctly, to recovery of ocular balance (Maddox Wing test) and by comparing pre- and postoperative performance in a paper and pencil test (the p-deletion test). After 3 hours all the patients were fit for discharge. Recovery tests showed no differences between the groups. All patients were satisfied with the anaesthesia. Full recovery took on average 1.5 days (range between 1 hour and 14 days) in both groups. Patients' opinion 1 month after the procedure should be included in every study concerning recovery. Anaesthesia by continuous propofol infusion results in quick recovery comparable with that following isoflurane anaesthesia.

Adolescent↗
PubMed1991

The neuromuscular blocking effect of Org 9426. A new intermediately-acting steroidal non-depolarising muscle relaxant in man.

Org 9426, a new steroidal non-depolarising muscle relaxant, which is stable in solution, was studied in 30 anaesthetised (thiopentone, fentanyl, nitrous oxide) male patients, ASA 1 or 2. A dose-response curve for Org 9426 was constructed and the ED90, mean (SD), was found to be 0.36 (0.031) mg/kg. The onset of action was 3.8 (1.8) minutes, the clinical duration 17.4 (3.2) minutes, the total duration of action 31.9 (6.2) minutes and the recovery time 9.96 (3.2) minutes. No signs of histamine release or cardiovascular effects were observed. Org 9426 thus has a faster onset of action than vecuronium bromide or atracurium dibesylate.

Adult↗
PubMed2007

Correlation between heart rate variability and haemodynamic fluctuation during induction of general anaesthesia: comparison between linear and non-linear analysis.

The objective of this study was to compare linear and non-linear analysis of heart rate variability (HRV) in terms of correlation with haemodynamic fluctuation during induction of general anaesthesia. Pre-operatively, HRV was estimated by the MemCalc method in 114 patients scheduled for general anaesthesia. After anaesthesia was induced with propofol, fentanyl and vecuronium bromide, tracheal intubation was performed. Haemodynamic fluctuations during induction of anaesthesia were recorded and the correlation between pre-operative HRV and haemodynamic fluctuation was examined using logistic regression analysis. As an index of non-linear analysis of HRV, ultra short-term entropy (UsEn) correlated better with blood pressure fluctuation than did the ratio of the power of low frequency component of HRV to that of high frequency component (LF/HF). In contrast, although LF/HF significantly correlated with heart rate increase caused by tracheal intubation, the correlation between UsEn and heart rate fluctuation was not significant.

Adult↗