Rocuronium versus suxamethonium for rapid sequence induction of general anaesthesia for caesarean section: influence on neonatal outcomes.

BACKGROUND: In a previous study we compared rocuronium and suxamethonium for rapid-sequence induction of general anaesthesia for caesarean section and found no difference in maternal outcome. There was however, a significant difference in Apgar scores. As this was a secondary outcome, we extended the study to explore this finding on a larger sample. METHODS: We included 488 parturients of whom 240 were women from the original study. Women were randomly assigned to receive either rocuronium 1mg/kg (ROC n=245) or suxamethonium 1mg/kg (SUX n=243) after propofol 2mg/kg. Anaesthesia was maintained with up to 50% nitrous oxide and up to one minimum alveolar concentration of sevoflurane until the umbilical cord was clamped. We compared neonatal outcome using Apgar scores and umbilical cord blood gases. RESULTS: Data were analysed for 525 newborns (ROC n=263vs. SUX n=262). There was a statistically significant difference in the proportion of Apgar scores <7 at 1min (ROC 17.5% vs. SUX 10.3%, P=0.023) but no difference at 5min (ROC 8% vs. SUX 4.2%, P=0.1) or 10min (ROC 3.0% vs. SUX 1.9%, P=0.58). There was no difference between groups in other measured outcomes. CONCLUSION: The use of rocuronium was associated with lower Apgar scores at 1min compared with suxamethonium. The clinical significance of this is unclear and warrants further investigation.

Establishment and evaluation of a post caesarean acute pain service in a perinatological center:retrospective observational study.

OBJECTIVE: The aim of this study was to determine the efficacy of establishing a Post Caesarean Acute Pain Service. DESIGN: Retrospective observational study. SETTING: University Hospital Brno. METHODS: We evaluated all patients undergoing delivery via Caesarean Section under anaesthesia in the periods 10/2009 - 9/2010 and 11/2010 - 10/2011. During the postoperative period at predefined times, we measured the Visual Analogue Scale, Additional Analgesic Requests, blood pressure, pulse rate and recorded any complications. We compared the Visual Analogue Scale Score and number of Additional Analgesic Requests in two groups of women, 212 patients before and 195 patients after the establishment of an Acute Pain Service in the first 72 hours after Caesarean Section. RESULTS: There was a statistically significant difference in Visual Analogue Scale Score between the groups (p<0.05). The number of Additional Analgesic Requests 24-72 hours after Caesarean Section decreased below one requirement per 24 hours. The most effective analgesic method after Caesarean Section during the first 24 hours postoperatively was epidural analgesia. There was no statistically significant difference 24-72 hours after Caesarean Section between the methods of analgesia used. CONCLUSION: In conclusion, implementation of a Post Caesarean Acute Pain Service led to decrease in Visual Analogue Scale Score postoperatively. KEYWORDS: Acute Pain Service, postoperative analgesia, Caesarean Section, non-opioid analgesia, opioid analgesia, epidural analgesia.

An open randomised comparison of ofloxacin and doxycycline in lower respiratory tract infections.

The efficacy and tolerance of ofloxacin and doxycycline were compared in patients with lower respiratory tract infections. Doses used were 200 or 400mg twice daily for ofloxacin and 100mg twice daily for doxycycline. Of 230 patients treated, 219 could be assessed for effectiveness. 88 patients were treated for exacerbations of chronic bronchitis and 131 for pneumonia. Clinical cure was achieved in 18 of 52 patients with bronchitis treated with ofloxacin. Improvement occurred in 29 and failure in 5. In the doxycycline-treated bronchitis group 11 of 36 patients were cured, 22 improved and 1 failure occurred. Of 62 patients with pneumonia who were administered ofloxacin, 34 were cured, 26 improved and treatment failed in 2. In the doxycycline-treated group of patients with pneumonia 39 of 69 were cured, 23 improved and 7 failed to respond. Two patients experienced adverse effects during ofloxacin treatment and 7 while receiving doxycycline.

[Complications of the use of microcatheters using Grandjean's technic in ergometry]. / Komplikationen beim Gebrauch von Einschwemmkathetern nach Grandjean während der Ergometrie.

The method of microcatheterism was described in the now usual form first by Grandjean in 1967. It offers an appropriate information about pressures in the pulmonary circulation at rest and during stress. This report gives a comprehensive survey about the complications with this method in a time range of seven years, from 1976 until 1982, in 4901 patients. The total rate of complications was very low (0.67%). Compared with a study about complications with Swan-Ganz-catheters in similar patients from Roskamm and co-workers, we found in our investigation a lower rate of dangerous arrhythmias. We conclude that microcatheterism is a simple, and cheap method, which is poor of risks. It is suitable ideally either for screening and control investigations or for the quantification of a cardiopulmonary disease.

Clinical assessment of a trimethoprim-sulfamethopyrazine combination (Kelfiprim) in lower respiratory tract infections.

The new combination of trimethoprim 250 mg and sulfamethopyrazine 200 mg was used in fourteen out-patients and eighteen in-patients with acute exacerbation of chronic bronchitis, pneumonia or bronchopneumonia due to sensitive bacteria. The drug was given for 1 to 2 weeks as one capsule daily (following a double loading dose on the first day), and ampicillin, 500 mg capsules q.i.d., was administered to another group of eleven in-patients for comparison. Overall results, based on clinical, radiological and laboratory findings, were excellent or good in 85% and 67%, respectively, of out- and in-patients receiving the combination drug; definite failures were one out of fourteen and two out of eighteen cases, and the remainder were assessed as fair. In three out of thirty-two patients mild to moderate gastro-intestinal side-effects were observed during treatment. The drug compared favourably to ampicillin for both effectiveness and safety.