Atracurio mas alcuronio en anestesia / Atracurio and alcuronio in anesthesia

Con el presente trabajo se busca demostrar los beneficios del ejemplo alternado en un mismo paciente de dos relajantes musculares no despolarizantes, en este caso atracurio y alcuronio, obteniendose condiciones optimas mas o menos rapidas de intubacion endo-traqueal, adecuada relajacion quirurgica, sin la necesidad de revertir a estos relajantes al finalizar el acto quirurgico. Disminuyendo de esta forma la dosis total de ambos relajantes, probabilidad de depresion respiratoria por relajacion residual post anestesica.

Effects of precurarisation on suxamethonium-induced postoperative myalgia during the first trimester of pregnancy.

Two hundred and fifty women undergoing termination of pregnancy during the first trimester under general anaesthesia were studied to determine the effects of precurarisation on suxamethonium-induced postoperative myalgia and on the need for postoperative analgesics after suxamethonium. Either alcuronium (0.03 mg/kg), atracurium (0.04 mg/kg), tubocurarine (0.05 mg/kg), vecuronium (0.01 mg/kg) or saline was administered in a double-blind manner 4 min before giving suxamethonium. An additional 50 patients were studied who received isoflurane rather than precurarisation and suxamethonium. Every pretreatment prevented fasciculations better than did saline (P less than 0.001). In the saline group, 92% of patients had fasciculations and in the other groups this ranged from 8 to 32%, respectively. On the first postoperative day, 76% of the patients in the saline group had myalgia while myalgia was manifested in 28, 54 and 34% of patients given alcuronium, tubocurarine or vecuronium, respectively (P less than 0.05). Atracurium failed in this effect with 62% having myalgia. In the isoflurane group, none of the patients complained of myalgia on the first postoperative morning. The need for analgesics was less (P less than 0.005) in the isoflurane group (8%) and in the pretreatment groups (18-27%) than in the saline group (42%). It is concluded that precurarisation with tubocurarine, vecuronium or, most effectively, with alcuronium but not with atracurium decreases suxamethonium-induced postoperative myalgia and seems to be necessary also during the first trimester of pregnancy.

Side effects and changes in pulmonary function after fixed dose precurarization with alcuronium, pancuronium or vecuronium.

On hundred and sixty premedicated patients undergoing surgery were assessed for changes in pulmonary function and signs of partial neuromuscular blockade following precurarization with a fixed dose of alcuronium 2 mg, pancuronium 1 mg or vecuronium 1 mg, and the efficacy of the drugs in the prevention of suxamethonium-associated side effects was compared. In this respect, no differences were observed between the three drugs. Pretreatment with alcuronium and pancuronium was followed by small decreases in pulmonary function. Statistically significant changes were seen only when vecuronium 1 mg was used as the fixed-dose precurarization agent.

Myalgia and biochemical changes following intermittent suxamethonium administration. Effects of alcuronium, lignocaine, midazolam and suxamethonium pretreatments on serum myoglobin, creatinine kinase and myalgia.

One hundred gynaecological patients for laparoscopy divided into five groups were studied to determine the effects of a number of pretreatments on serum myoglobin, creatinine kinase and myalgia following intermittent suxamethonium administration. One group acted as controls, while the other groups were given intravenous pretreatments of alcuronium 2 mg, midazolam 0.15 mg/kg, lignocaine 1.5 mg/kg and suxamethonium 7 mg. Serum myoglobin was determined by radio-immunoassay. The mean increases in the control group were 167 micrograms/litre myoglobin at 20 minutes and 196 IU creatinine kinase at 24 hours; 13 out of 20 patients responded with a marked increase of serum myoglobin at 20 minutes and of creatinine kinase at 24 hours. Only alcuronium pretreatment prevented myoglobin increase at 20 minutes, abolished creatinine kinase increase at 24 hours and reduced 24-hour myalgia. The other pretreatments slightly reduced myoglobin increase at 20 minutes and 24-hour creatinine kinase but did not reduce myalgia. Only one patient in the whole study had markedly elevated serum myoglobin at 24 hours. We conclude that only non-depolarising relaxant pretreatment is effective in the reduction of some of the adverse effects of suxamethonium administration.

Biochemical changes following suxamethonium. Serum myoglobin, potassium and creatinine kinase changes before commencement of surgery.

Forty patients were investigated for serum myoglobin changes following induction of anaesthesia but before the commencement of surgery. Blood was drawn for potassium, creatinine kinase and serum myoglobin immediately prior to and 5, 10 and 20 minutes after administration of thiopentone 4 mg/kg and suxamethonium 1.2 mg/kg. Twenty patients were given either 2 mg alcuronium or 20 mg gallamine as pretreatment 2 to 3 minutes before the suxamethonium to reduce the fasciculations. Anaesthesia was maintained with artificial ventilation and alcuronium, or spontaneous ventilation with halothane. Serum myoglobin was assayed by radioimmunoassay. All pre-induction myoglobin levels were within the normal range. Of the 20 patients who were not pretreated, six showed a marked rise of serum myoglobin within 5 minutes, increasing to 150-200 micrograms/litre at 20 minutes. The remaining 14 patients had no such rise. No patients in the pretreatment group had any significant rise in serum myoglobin, suggesting that although the fasciculations were not completely abolished, there was protection against one of the effects of suxamethonium on the muscle. Although there was no clear relationship between intensity of fasciculations and increase in serum myoglobin, there was no marked rise in serum myoglobin values in any patient who did not have muscle fasciculations. There were no consistent changes in potassium or creatinine kinase in any group during the period of study.

Resistance to competitive neuromuscular blocking agents in burn patients: a review.

The quantitative and qualitative aspects of the phenomenon of resistance to competitive (non-depolarizing) neuromuscular blocking agents in burn patients are described. The correlates and temporal features of this resistance are discussed, in addition to therapeutic approaches and the possible mechanisms underlying the resistance.

Results of treatment of patients with severe tetanus. A study o 18 cases.

From 1964 to 1980 a total of 18 patients with tetanus were treated at Tampere Central Hospital, 5 (28%) of whom died. No assurance regarding earlier immunization could be obtained in 15 cases. In 13 cases the site of infection was a small scratch on the finger, the legs or the face. The mean incubation period was 8 days. Ten patients suffered from severe tetanus and 8 from moderate tetanus. Eight patients, of whom 2 died, were treated in an ordinary ward. After the surgical intensive care unit was set up, 10 patients received treatment there. Three died. The mean duration of hospitalization was 27 days and the mean treatment period in the intensive care unit 24 days. Seven patients were asymptomatic when discharged and 6 had minor after-effects. Cardiovascular complications can be prevented by intensive care, but pulmonary embolism remains the commonest cause of death. Special attention should be paid to its prevention.

The effect of different modes of artificial ventilation and of some prophylactic means on the incidence of postoperative deep vein thrombosis.

The occurrence of postoperative deep vein thrombosis (DVT) was studied in 209 elective surgery patients aged 40 years or over. Most of the operations were cholecystectomies or other major abdominal operations. In the detection of thrombosis the 125I-fibrinogen method was used. Of 209 patients, 51 (24.4%) developed postoperative DVT and of these 10 developed thrombosis in both legs. In 36% of the DVT cases the process started during the operation or on the first postoperative day. Clinical signs of DVT did not agree with the 125I-fibrinogen test very well, whereas the correlation of the 125I-fibrinogen test with phlebography was good: of the 17 patients with a postive 125I-fibrinogen test in whom a phlebography was done, the latter method revealed thrombosis in 14 patients (82.4%). The main purpose of the study was to determine whether the mode of mechanical ventilation used during anaesthesia has any effect on the occurrence of postoperative DVT. One hundred and nine patients received intermittent positive pressure ventilation (IPPV), whereas in 100 patients the intrathoracic pressure was decreased by applying intermittent positive-negative (--5 cmH2O) pressure ventilation (IPNPV). Ventilation was standardized in both groups by keeping the end-tidal CO2% at a constant level. Inspired oxygen concentration was the same in every patient. The decreasing effect of IPNPV on intrathoracic pressure and central venous pressure as compared with IPPV was confirmed in preliminary studies.