Rapid intubation with fazadinium

The speed of onset and intubation conditions have been compared for suxamethonium 1 mg/kg, alcuronium 0-32 mg/kg and fazadinium 1 mg/kg and 1-25 mg/kg. Fazadinium 1 mg/kg was not significantly different in times to intubation from suxamethonium although the latter gave a highly significant greater number of patients with excellent conditions. The higher dose of 1-25 mg/kg fazadinium did not give significantly better intubating conditions than the lower dose. Although the times to intubation for the two dose levels of fazadinium did not differ statistically, the higher dose was significantly slower in onset than suxamethonium. Alcuronium was slower than either suxamethonium or fazadinium 1 mg/kg in producing satisfactory conditions. The nondepolarizing drug, fazadinium, may be a useful neuromuscular blocking agent in emergency cases where rapid intubation is required and when it is wished to avoid possible or probable adverse effects from the depolarising drug suxamethonium.     

Prolonged curarisation following renal transplantation

A retrospective study of postoperative respiratory morbidity in 247 patients requiring renal transplantation between 1955 and 1973 showed that 7 patients required postoperative controlled ventilation for up to 6 days. The nondepolarising relaxants tubocurarine and pancuronium were used in only 65 patients, but all 7 cases of respiratory failure occurred in this group. This suggests that the use of these drugsin anephric patients is potentially hazardous so far as postoperative respiratory insufficiency is concerned.     

Vitamin C and post-suxamethonium pains

A double-blind trial of the effects of vitamin C on the frequency, severity and duration of post-suxamethonium pains was performed. Fifty-three patients undergone bronchoscopy received either a placebo or 10 g of vitamin C. No beneficial effect was demonstrated. In 18 patients no relationship was found between pre-anaesthetic buffy layer vitamin C levels and the subsequent pains. Measurement of buffy layer and plasma vitamin C levels before and after anaesthesia did not suggest that vitamin C deficiency occurs during or immediately after administration of suxamethonium. It is concluded that the administration of vitamin C cannot be recommended as a means for prevention of suxamethonium pains.     

The effect of thiopentone and fazadinium on intraocular pressure

Intraocular pressure was measured in twenty-four patients using an applanation tonometer, after using thiopentone and fazadinium as induction agents. No significant rise in intraocular pressure above resting levels was noted before or after tracheal intubation, and it is suggested that this combination of induction agents should be satisfactory for general anaesthesia of a patient with a perforating eye injury who presents with a full stomach.     

Dantrolene and suxamethonium

A single oral dose of dantrolene (100--150 mg) given at least 2 hr pre-operatively has been found to reduce significantly the strength of muscular fasciculations, the hyperkalaemia and the incidence of muscle pains following suxamethonium (from 56 to 4%) in a series of forty-eight patients compared with controls. The biceps EMG of the fasciculations was unchanged by dantrolene; the incidence of troublesome side effects was low (9%) and there did not appear to be any alteration in the duration of action of suxamethonium.     

The interaction of halothane and pancuronium bromide

The interaction of halothane and pancuronium is demonstrated in the dog tibialis anterior-sciatic nerve preparation. The results show a dose related effect of halothane on the recovery index and the 50% recovery times. These results are compared to other reports and possible mechanisms are discussed.     

Thiopentone and pancuronium crash induction

A method of 'crash induction' using pancuronium and thiopentone was studied in 100 patients at risk from vomiting or regurgitation. The technique was inferior to thiopentone/suxamethonium in terms of time to intubation, activity of vocal cords and responses to stimuli during induction. Six cases gave difficulty with intubation due to poor relaxation. Only two patients had a fall in systolic blood pressure of more than 20% following induction. No regurgitation occurred. The technique may be suitable for skilled anaesthetists in cases when suxamethonium is relatively contraindicated, when large doses of pancuronium can be used or when hypotension is likely to follow induction.     

Reversal of neuromuscular blockade by glycopyrrolate and neostigmine

The effect of intravenous glycopyrrolate and neostigmine, a drug combination routinely given to antagonize non-depolarising neuromuscular blockade, on lower oesophageal sphincter tone was studied in twenty patients undergoing Caesarean section. Glycopyrrolate 0.6 mg and neostigmine 2.5 mg i.v. increased LOS pressure insignificantly by a mean of 0.2 kPa (P less than 0.1). In contrast, glycopyrrolate 0.6 mg and neostigmine 5 mg increased LOS pressure by a mean of 1.2 kPa (P less than 0.001). The latter dosage of this drug combination thus appears preferable in patients presenting for emergency surgery, if the integrity of the lower oesophageal sphincter is to be maintained during extubation and recovery from general anaesthesia.     

Serum creatine kinase levels after succinylcholine in children with “muscle,eye and brain disease“

Four boys belonging to a group of children affected by a rare form of muscular dystrophy with eye and brain involvement, termed the "muscle, eye and brain disease" (MEB), were anaesthetized for various eye examinations and surgery. On some occasions succinylcholine was used during anaesthesia and the initially elevated serum creatine kinase (CK) values increased from a range of 122 to 1200 units.L-1 to a range of 4350 to 9690 units.L-1 22 hours after anaesthesia. CK values after anaesthesia without succinylcholine remained at the initially elevated levels. Rectal temperatures of the children were normal. These findings suggest that succinylcholine should be avoided in patients with MEB disease.     

Continuous infusion of propofol in dystrophia myotonica

The use of intravenous infusions of propofol and atracurium in a 41-year-old woman, weighing 64 kg, with dystrophia myotonica during major oral surgery is described. Propofol and atracurium, in total doses of 2488 mg and 75 mg respectively, were used during the four-hour procedure. There were no intraoperative problems and operating conditions were excellent. Emergence was rapid and there were no postoperative complications. This technique offers a safe alternative to inhalational anaesthesia for patients with dystrophia myotonica.     

Plasma potassium, sodium and blood sugar following etomidate and suxamethonium

Changes in plasma potassium, sodium and blood sugar were studied in Nigerian patients following induction of anaesthesia with etomidate and suxamethonium. Healthy patients presenting for elective surgery as well as psychiatric patients presenting for electroconvulsive therapy were studied. Plasma potasium was essentially unaffected by etomidate administration, but rose significantly when suxamethonium was given. This rise was higher than that observed with thiopentone and suxamethonium in a previous study on a similar group of Nigerians. Blood sugar was not significantly increased by the administration of etomidate but rose significantly after suxamethonium was given. This hyperglycaemic response was greater than when thiopentone was used as the induction agent. Administration of ECT was associated with a further increase in blood sugar. It is concluded that thiopentone is preferable to etomidate in situations where increases in plasma potassium and blood sugar are undesirable following administration of suxamethonium.