Symposium on Benzylisoquinolinium Muscle Relaxants - Innovations and Issues, Publisher: MUNKSGAARD INT PUBL LTD, Pages: 30-34, ISSN: 0001-5172
Acta Anaesthesiol Scand Suppl, Vol: 106, Pages: 30-34, ISSN: 0515-2720
Mivacurium, a new benzylisoquinoline muscle relaxant, appears to be close to the ideal for short to intermediate surgical procedures. Ideal properties of such an agent are discussed, in addition to indications for muscle relaxation in such procedures. Two studies are presented, showing the onset and offset times of mivacurium and its cardiovascular stability in both young and elderly patients. It is concluded that it is a well-tolerated and appropriate agent for use in short to intermediate surgical procedures in those patients with normal plasma cholinesterase function, despite a slight prolongation of action in the elderly.
COMPARISON OF DESFLURANE AND FENTANYL-BASED ANESTHETIC TECHNIQUES FOR CORONARY-ARTERY BYPASS-SURGERY, BRITISH JOURNAL OF ANAESTHESIA, Vol: 72, Pages: 430-438, ISSN: 0007-0912
A laboratory study., Anaesthesia, Vol: 47, Pages: 936-938, ISSN: 0003-2409
The accuracy of 21 anaesthetists in estimating tidal volumes from reservoir bag movements was assessed using a model lung apparatus. The breathing system configuration (Mapleson A or D), the grade of anaesthetist, and the years of anaesthetic experience had no effect on accuracy. Greater precision of tidal volume estimation was observed with larger tidal volumes and lower fresh gas flows. The mean systematic error of 18 of the 21 anaesthetists was greater than zero, indicating a general tendency to overestimate tidal volume. This study therefore strengthens the view that clinical observations should be supplemented with information from continuous monitoring devices.
Mivacurium chloride: a study to evaluate its use during propofol-nitrous oxide anaesthesia., Anaesthesia, Vol: 47, Pages: 653-657, ISSN: 0003-2409
We assessed the neuromuscular and cardiovascular effects of mivacurium chloride, a neuromuscular blocking agent, in 33 patients during propofol-nitrous oxide anaesthesia. Neuromuscular function was assessed with supramaximal stimuli of the ulnar nerve, using surface electrodes at the wrist, with repeat trains of four. Mivacurium given as a bolus of 0.15 mg.kg-1 (ED95 x 2) was found to be haemodynamically stable. Intubating conditions assessed at 2 and 2.5 min were either good or excellent. All patients developed a block of 100% in a mean (SD) time of 105 (34) s. There were mean (SD) intervals of 12 (2.4) min before the reappearance of the first twitch of the train of four (T1) following the bolus dose, and 15.8 (3.1) min for the T1 to reach 25% of its control value (TC). Seventeen patients received an infusion of mivacurium to maintain neuromuscular blockade (T1:TC 10-20%) with a mean (SD) infusion rate of 6.9 (2.2) micrograms.kg-1.min-1. Recovery from neuromuscular blockade was assessed with spontaneous offset or augmented with edrophonium following either the initial bolus or an infusion. Following a bolus it took a mean (SD) of 26.2 (3.7) min for the fourth twitch of the train of four (T4):T1 ratio to reach 0.7. In patients receiving an infusion with spontaneous offset it took a mean (SD) time of 12.0 (2.2) min to reach the T4:T1 ratio of 0.7 from a T1:TC value of 8.8. Edrophonium significantly decreased the recovery time in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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