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ABSTRACT: The purpose of the present study was to evaluate in detail the suitability of the combined use of fentanyl and propofol for endotracheal oral intubation without non-depolarizing muscle relaxants (NDMRs) for myasthenic patients. We evaluated orotracheal intubation, without using an NDMR, having induced anesthesia with 2 microg x kg(-1) fentanyl and 2.5 mg x kg(-1) propofol in myasthenic (Osserman's classification: I-IIb) and non-myasthenic patients. Using this technique, intubation was easily performed, the vocal cords remained opened, and any increase in blood pressure was satisfactorily suppressed in both myasthenic and non-myasthenic patients. In non-myasthenic patients, whose train-of-four ratio recorded immediately before intubation was 95-100%, a cough of moderate or severe intensity occurred. In myasthenic patients, no or only a slight cough occurred if the ratio was less than 75%, and a cough of moderate intensity occurred if the ratio was more than 90%. All of th coughing reflexes observed in myasthenic patients were considered to be clinically acceptable. The results indicate that the combined fentanyl and propofol technique, without NDMR, provides satisfactory intubatin conditions in myasthenic patients.
Journal of medicine 02/2003; 34(1-6):47-58.
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ABSTRACT: To determine the effects of respiratory acidosis and alkalosis by mechanical ventilation on the onset, duration, and recovery times of vecuronium.
Randomized, prospective study.
Operating rooms in the Sapporo Medical University Hospital and Kitami Red Cross Hospital.
90 ASA physical status I and II patients undergoing lower abdominal surgery.
Patients were randomly allocated to one of three groups by arterial carbon dioxide tension level (PaCO2; mmHg) after induction: hyperventilation group (PaCO2 = 25-35), normoventilation group (PaCO2 = 35-45), and hypoventilation group (PaCO2 = 45-55). Anesthesia was maintained by spinal block with inhalation of 50% to 66% nitrous oxide in oxygen and intermittent intravenous administration of fentanyl and midazolam with tracheal intubation.
After vecuronium 0.08 mg/kg was given, onset, duration, and recovery time were measured by mechanomyography (Biometer Myograph 2,000, Odense, Denmark). There were significant differences in the duration and recovery time of vecuronium among the normoventilation group (12.7 +/- 3.3 min and 11.8 +/- 2.8 min, respectively), the hyperventilation group (10.6 +/- 3.5 min and 9.2 +/- 2.7 min, respectively; p < 0.01), and the hypoventilation group (14.4 +/- 3.1 min and 15.0 +/- 3.7 min, respectively; p < 0.01) (mean SD). The closest significant correlation in this study was observed between recovery time and arterial blood pH (r = 0.57; p < 0.05).
In humans, duration and recovery times of vecuronium are prolonged in respiratory acidosis and shortened in respiratory alkalosis.
Journal of Clinical Anesthesia 03/2002; 14(2):98-101. · 1.21 Impact Factor
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ABSTRACT: PurposeTo evaluate the onset of vecuronium neuromuscular blockade in the hand with an arteno-venous shunt for haemodialysis.
MethodsIn 15 adult patients receiving haemodialysis for renal failure the onset of vecuronium-induced neuromuscular blockade after
0.08 mg·kg−1 vecuroniumiv was measured. Using train-of-four mechanomyographic monitoring, the force of contraction of the adductor pollicis of both
hands with and without arteno-venous shunt was measured simultaneously.
ResultsThe times from the injection to the first depression of twitch response (latent onset) and 95% twitch depression (onset) in
the hand with and without arteno-venous shunt were114.7 ± 33.4 and 218.7 ± 59.9 and 117.3 ± 34.3 and 208.7 ± 60.9 sec respectively.
No difference in the onset of vecuronium neuromuscular blockade in the hand an arterio-venous shunt was demonstrated.
ConclusionThe presence of an artenovenous fistula does not modify the onset on neuromuscular blockade. Either arm can be used to monitor
onset of neuromuscular blockade in chronic renal failure patients with an arterio-venous shunt in the hand for haemodialysis
ObjectifÉvaluer au niveau de la main l’installation du bloc neuromusculaire au vécuronium chez des porteurs d’un shunt arténoveineux
intallé pour l’hémodialyse.
MéthodesOn a mesuré chez 15 adultes hémodyalisés pour insuffisance rénale l’intallation du bloc neuromusculaire après l’administration
de 0.08 mg·kgt-1
iv de vécuronium. Des moniteurs mécanomyographiques ont servi à mesurer le force de contraction de l’adducteur du pouce aux
deux mains dont celle du shunt arténoveineux.
RésultatsLes intervalles mesurés entre l’injection et la dépression du premier twicht (latence d’installation) et 95% (installation)
avec et sans snunt artérioveineux étaient respectivement de 114,7 ± 33,4 et 218,7 ± 59,9 et 117,3 ± 34,3 et 208,7 ± 60,9 s.
Lintallation du bloc neuromusculaire au vécuronium ne différait pas du côté shunt.
ConclusionLa présence d’une fistule arténoveineuse ne modifie pas l’installation du bloc neuromusculaire. On peut utiliser indifféremment
les deux bras pour le monitorage de l’intallation du bloc neuromusculaire chez les insuffisants rénaux chroniques porteur
d’un shunt artérioveineux pour hémodialyse.
Canadian Journal of Anaesthesia 10/1997; 44(11):1208-1210. · 2.35 Impact Factor
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Canadian Journal of Anaesthesia 01/1996; 43(12):1277-1277. · 2.35 Impact Factor
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ABSTRACT: PurposeTo measure the electromyographic (EMC) responses of the phasic discharge in the cricothyroid (CT; a tensor muscle of the vocal
folds) and the posterior cricoarytenoid (PCA; sole abductor muscle of the vocal folds) following intravenous infusion of propofol
1.0 mg · kg−1 · min−1, thiamylal 1.0 mg · kg−1 · min−1, or ketamine 0.5 mg · kg−1 · min−1 for five minutes.
DesignProspective, nonrandomized, controlled animal study. Setting: University research laboratory. Subjects: Fifteen mongrel dogs,
including three groups of five animals in each group.
InterventionsUnder 0.2–0.3% halothane and oxygen anesthesia with spontaneous ventilation, phasic EMG activities of the CT and PCA muscles
were recorded in an identical manner after the administration of each drug.
Measurements and main resultsPropofol infusion produced almost equal suppression of EMG activity of the CT and the PCA with lime and three minutes after
the start of infusion of propofol there was a significant depression of the phasic activities in the both muscles; EMG activity
of the CT and the PCA was 33.8 ± 21.2 and 36.6 ± 22.9% (% of control, mean ± SD) respectively P < 0.05). Thiamylal selectively
reduced rhythmic discharges in the CT muscle during spontaneous breathing and significant depression of discharge in the CT
muscle was observed three minutes after the drug (47.3 ± 24.9%, P < 0.05). In contrast, both phasic EMG activities of the
CT and the PCA were rhythmically active and the differential sensitivity between the CT and the PCA muscles was not observed
after ketamine, even after ten minutes of administration.
ConclusionsThis study confirms a difference in sensitivity between the CT and the PCA muscles, demonstrating that the intrinsic laryngeal
muscles do not behave similarly after the administration of conventional intravenous anaesthetic agents.
ObjectifMesurer la réponse électromyographique (EMG) de la décharge phasique du muscle cricothyrodien (CT: un des muscles tenseurs
des cordes vocales) et la cricoaryténodien postérieur (CAP: le seul muscle abducteur des cordes vocales) après une perfusion
intraveineuse de propofol 1,0 mg · kg−1· min−1, de thyamilal 1,0 mg · kg−1 · min−1 ou de kétamine 0,5 mg · kg−1 · min−1 pendant cinq minutes.
Organisation de l’étudeProspective, non aléatoire, contrôlée, sur des animaux.
MilieuLaboratoire de recherche universitaire.
SujetsQuinze chiens de race commune divisés en trois groupes de cinq.
InterventionsSous anesthésie en ventilation spontanée à l’halothane 0,2–0,3% en oxygène, l’activité phasique EMG des muscles CT et CAP
est enregistrée de manière identique après l’administration de chaque agent.
Mesures et principaux résultatsLa perfusion de propofol produit une suppression presque identique de l’activité EMG du CT et CAP avec le temps. Trois minutes
après le début de la perfusion de propofol, on constate une dépression importante de l’activité phasique des deux muscles;
l’activité phasique du CT et du CAP est respectivement de 33,8 ± 21,2 et 36,6 ± 22,9 (% du contrôle, moyenne ± ET, P < 0,05).
Par contre, l’activité EMG phasique du CT et du CAP était en harmonie et une différence de sensibilité entre les muscles CT
et CAP n’a pas été observée avec la kétamine, même après dix minutes d’administration.
ConclusionCette étude confirme la différence de sensibilité qui existe entre les muscles CT et CAP et démontre que les muscles intrinseques
du larynx ne se comportent pas de la même façon après l’administration des anesthésiques intraveineux usuels.
Canadian Journal of Anaesthesia 12/1995; 43(1):39-43. · 2.35 Impact Factor
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ABSTRACT: This study was designed to investigate differences in epidural analgesic spread between catheter and needle injections in
48 patients with comparable physical characteristics. The spread of analgesia in the catheter injection group with a 0.24
ml·sec−1 injection rate (n=16) was 16.8±1.5 spinal segments and that in the needle injection group at the same injection rate (n=16)
was 12.5±1.8 spinal segments (P<0.01). Needle injection at the faster rate of 1.2 ml·sec−1 (n=16) produced a significantly greater spread of analgesia than with the 0.24 ml·sec−1 rate through the needle (16.2±1.6 vs 12.5±1.8 spinal segments,P<0.01). Thirteen of 16 patients receiving the fast needle injection complained of back compression or discomfort during the
injection.
The injection through an epidural catheter and the fast (1.2 ml·sec−1) injection through a needle produced extensive and equivalent epidural analgesic spread. However, because of patient discomfort
with fast injection through the needle, the authors conclude that when using continuous epidural anesthesia, the initial injection
of local anesthetic should be administered through the epidural catheter not the needle.
Key wordsepidural-lidocaine
Journal of Anesthesia 04/1992; 6(3):289-293. · 0.83 Impact Factor
