Intubationsbedingungen nach Rocuronium und Succinylcholin

OBJECTIVE Rocuronium is a new non-depolarising steroidal muscle relaxant with a short onset time. The present study was undertaken to compare intubating conditions as well as onset and clinical duration of a single dose of 0.6 mg/kg (2 x ED95) with a single dose of 1 mg/kg suxamethonium (3 x ED95). METHODS After obtaining informed consent and approval of the Ethics Committee, 40 adult patients (ASA I-III) participated in this study. After premedication with oxazepam, anaesthesia was induced with fentanyl and propofol and maintained with propofol, N2O and supplements of fentanyl as needed. Muscular relaxation was assessed by EMG recording of adductor pollicis muscle after supramaximal single…

Beeinflussung der Pharmakodynamik von Rocuronium durch Cimetidin

Nach Gabe von Cimetidin kann die Wirkungszeit nichtdepolarisierender Muskelrelaxanzien verlangert sein. Wir untersuchten diesen Zusammenhang fur Rocuronium nach einer Einzeldosis von 400 mg Cimetidin intravenos im Vergleich mit einer Kontrollgruppe. Die Antwort des M. adductor pollicis nach Stimulation des N. ulnaris wurde elektromyographisch registriert. Die Anschlags- und Erholungszeiten sind in beiden Gruppen vergleichbar. Der fehlende Einflus von Cimetidin auf die neuromuskulare Blockade von Rocuronium konnte darauf hindeuten, das die Elimination von Rocuronium nicht nur in der Leber stattfindet. Eine mogliche direkte Beeinflussung der neuromuskularen Endplatte durch Cimetidin, wie sie …

Die Wirkung des Alters auf Anschlagszeit und Erholung nach Atracurium, Rocuronium und Vecuronium

Bei alten Patienten kann die Wirkung von Muskelrelaxanzien verandert sein. Wir untersuchten diesen Zusammenhang an 108 Patienten dreier Altersgruppen, die randomisiert klinisch ubliche Intubationsdosen von Atracurium, Rocuronium und Vecuronium erhielten. Anschlagszeit und Erholung von der neuromuskularen Blockade wurden mit dem evozierten EMG des M. adductor pollicis nach Stimulation des N. ulnaris (Einzelreizung, 0,1 Hz) ermittelt. Die Anschlagszeiten sind in allen drei Altersgruppen vergleichbar, die Erholungszeiten bei den alten Patienten nach allen drei Relaxanzien verlangert. Die verlangerte Erholungszeit fur Rocuronium korreliert mit erhohten Werten der berechneten Kreatinin-Clearance…

Zum Einflu� der pr�isch�mischen Blutzuckerkonzentration auf H�modynamik und regionale Organdurchblutung w�hrend und nach kardiopulmonaler Reanimation (CPR) beim Schwein

Gegenstand der vorliegenden Untersuchung im Schweinemodell ist der Einflus einer pra-ischamischen Normo-, Hyper- oder Hypoglykamie auf Hamodynamik, regionale Organdurchblutung und Reanimierbarkeit nach 3minuti-gem unbehandelten Herz-Kreislauf-Stillstand und anschliesender kardiopulmonalen Reanimation (CPR). Hypoglykamie (Blutzuckerkonzentration von 34±2 mg/dl) war bereits vor der Reanimation mit einer deutlichen Beeintrachtigung hamodynamischer Parameter assoziiert. Keines der hypoglykamischen Tiere konnte erfolgreich reanimiert werden, im Gegensatz zu den hyper- (Blutzucker 319±13 mg/dl) bzw. normoglykamischen Tieren, die keinen Unterschied hinsichtlich der Erfolgsrate der Reanimation aufw…

The Hemodynamic Effects of Ephedrine on the Onset Time of Rocuronium in Pigs

Several studies have found a correlation between the onset time of muscle relaxants, cardiac index, and muscle blood flow. Ephedrine increases these hemodynamic variables and shortens onset time of rocuronium in humans. Our aim in this animal study was to determine the effect of ephedrine on the onset time of rocuronium, cardiac index, and muscle blood flow after administration of thiopental. At predefined measuring points, mean arterial blood pressure and cardiac index were measured invasively and onset time was determined mechanomyographically. Twenty-four pigs were randomly assigned to three groups. Group I received etomidate and subsequently rocuronium (2 x 95% effective dose). Instead …

Gastric insufflation pressure, air leakage and respiratory mechanics in the use of the laryngeal mask airway (LMA) in children.

Summary Background : The objective of the present study was to evaluate the prelaryngeal position of the laryngeal mask airway (LMATM) in children, and to determine the influence of mask positioning on gastric insufflation and oropharyngeal air leakage. Methods : A total of 100 children, 3–11 years old, scheduled for surgical procedures in the supine position under general anaesthesia were studied. After clinically satisfactory LMA placement, tidal volumes were increased stepwise until air entered the stomach, airway pressure exceeded 30 cmH2O, or air leakage from the mask seal prevented further increases in tidal volume. LMA position in relation to the laryngeal entrance was verified using…

Effects of normobaric oxygen on ciliary beat frequency of human respiratory epithelium

Respiratory infection is a major cause of morbidity after general anaesthesia. Impairment of respiratory ciliary beat frequency (CBF) by different stress factors causes a decrease in mucus transport rate (MTR). We have tested the effect of different concentrations of oxygen on CBF of human respiratory epithelium in a prospective, randomized, in vitro study. Samples of superficial mucosa of the inferior nasal turbinates of 20 non-smoking healthy volunteers were harvested and exposed to three different oxygen environments (group I = 21% oxygen, group II = 60% oxygen and group III = 95% oxygen) for 2 h. In 50% of the samples, exposure time was prolonged. At 30, 60, 90, 120 and 240 min, light m…

Adherence issues related to sublingual immunotherapy as perceived by allergists.

Silvia Scurati1, Franco Frati1, Gianni Passalacqua2, Paola Puccinelli1, Cecile Hilaire1, Cristoforo Incorvaia3, Italian Study Group on SLIT Compliance 1Scientific and Medical Department, Stallergenes, Milan, Italy; 2Allergy and Respiratory Diseases, Department of Internal Medicine, Genoa; 3Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, ItalyObjectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered…

Laryngeal Mask Airway Position and the Risk of Gastric Insufflation

A potential risk of the laryngeal mask airway (LMA) is an incomplete mask seal causing gastric insufflation or oropharyngeal air leakage.The objective of the present study was to assess the incidence of LMA malpositions by fiberoptic laryngoscopy, and to determine their influence on gastric insufflation and oropharyngeal air leakage. One hundred eight patients were studied after the induction of anesthesia, before any surgical manipulations. After clinically satisfactory LMA placement, tidal volumes were increased stepwise until air entered the stomach, airway pressure exceeded 40 cm H2 O, or air leakage from the mask seal prevented further increases in tidal volume. LMA position in relatio…

Adaptive Lung Ventilation (ALV) Evaluierung eines neuen closed loop-gesteuerten Beatmungsalgorithmus bei Eingriffen in �berstreckter Seitenlage

The lateral decubitus position is the standard position for nephrectomies. There is a lack of data about the effects of this extreme position upon respiratory mechanics and gas exchange. In 20 patients undergoing surgery in the nephrectomy position, we compared a new closed-loop-controlled ventilation algorithm, adaptive lung ventilation (ALV), which adapts the breathing pattern automatically, to the respiratory mechanics with conventionally controlled mandatory ventilation (CMV). The aims of our study were (1) to describe positioning effects on respiratory mechanics and gas exchange, (2) to compare ventilatory parameters selected by the ALV controller with traditional settings of CMV, and …

Respiratory Mechanics, Gastric Insufflation Pressure, and Air Leakage of the Laryngeal Mask Airway

A potential risk of the laryngeal mask airway (LMA) is incomplete mask seal, which causes air leakage or insufflation of air into the stomach. The objective of the present study was to assess respiratory mechanics, quantify air leakage, and measure gastric air insufflation in patients ventilated via the LMA. Thirty patients were studied after induction of anesthesia but prior to any surgical manipulations. After the insertion of the LMA, patients were ventilated with increasing tidal volumes until one of the three following end points were reached: 1) gastric air insufflation, 2) airway pressure > 40 cm H2O, or 3) limitation of further increase in tidal volume by air leakage. The following …

Intraoperative Überwachung der Relaxierung