[Addition of muscle relaxants to intravenous regional anesthesia]. / Zusatz von Muskelrelaxantien zur intravenösen Regionalanaesthesie.

Nine volunteers received two intravenous regional anaesthetics in the right arm. The first anaesthetic was performed with plain 0.25% lignocaine (dose 1 ml/kg body weight), the second with the same volume of lignocaine, with the addition of 0.5 mg pancuronium-Bromide. Latency for onset of the following was measured in both groups: 1. analgesia, 2. cold sensation, 3. warm sensation, 4. touch, 5. motor blockade. As expected, the addition of pancuronium had no influence on sensory blockade, however, motor block was significantly stronger, faster in onset, and longer in duration. Significant systemic side effects after pancuronium were not observed. No pancuronium was found in flame photometry plasma studies. On the basis of these investigations, one can recommend, for I.V.R.A., a relatively large volume of dilute local anaesthetic solution and, to achieve better muscle relaxation, the addition of 0.5 mg of pancuronium.

Anaesthetic practice and postoperative pulmonary complications.

The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty-nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. A total of 290 patients (4.1%) suffered from one or more postoperative pulmonary complications. Six thousand and sixty-two patients received general anaesthesia and 4.5% of these had postoperative pulmonary complications. Of the patients admitted to major surgery receiving pancuronium, 12.7% (135/1062) developed postoperative pulmonary complications, compared to only 5.1% (23/449) receiving atracurium (P < 0.05). When stratified for type of surgery and duration of anaesthesia, conventional statistics showed no difference between pancuronium and atracurium as regard postoperative pulmonary complications. However, a logistic regression analysis indicated that long-lasting procedures involving pancuronium entailed a higher risk of postoperative pulmonary complications than did other procedures. In patients having regional anaesthesia, only 1.9% (18/967) developed postoperative pulmonary complications (P < 0.05 compared to general anaesthesia). However, when stratified for type of surgery there was a significantly higher incidence of postoperative pulmonary complications only in patients undergoing major orthopaedic surgery under general anaesthesia, 11.5% compared to 3.6% in patients given a regional anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Anestesia regional en pediatría / Regional anesthesia in pediatrics

El objetivo de este artículo es presentar una revisión actualizada sobre los bloqueos en pediatría, ya sea como anestesia mixta o como técnica única con premedicación; sus indicaciones y contraindicaciones. En este trabajo, se analizan las técnicas empleadas con más frecuencia en nuestro servicio. Se resumen los fármacos nuevos y los más frecuentes, sus usos y las fórmulas para calcular la dosis según el tipo de bloqueo y el peso corporal. Es importante subrayar que, en la actualidad, al seleccionar un tipo de anestesia, se deben considerar tres elementos que, de mayor a menor importancia, son: seguridad, riesgo/beneficio y costos. Concluimos en que el éxito de los bloqueos depende de un acabado conocimiento de la anatomía, de la percepción tridimensional de la zona en cuestión y, por supuesto, de la experiencia del operador.