Comparison of duration of neuromuscular blocking effect of atracurium and vecuronium in young and elderly patients

In a controlled, randomized study, we evaluated duration ofneuromuscular block in 80 patients undergoing routine abdominalsurgery. Forty patients were aged 18–50 yr (control group)and 40 patients were more than 65 yr (elderly group). All patientshad normal plasma creatinine concentrations. After inductionof anaesthesia, patients were allocated randomly to receiveeither atracurium 0.5 mg kg^–1 or vecuronium 0.1 mg kg^–1to facilitate tracheal intubation. Monitoring of the evokedresponse of the adductor pollicis muscle to supramaximal singletwitch ulnar nerve stimulation every 10 s was performed andmeasured with a strain gauge. Repeat doses of atracurium 0.1mg kg^–1 or vecuronium 0.02 mg kg^–1 were administeredwhen the adductor pollicis response recovered to 25% of thecontrol twitch height. We found that the duration of actionof the initial dose of atracurium was similar in the controland elderly groups, and it did not vary after repeated doses.However, the initial dose of vecuronium caused a significantlylonger period of clinical block in the elderly group comparedwith the controls, and the duration of action of repeated doseswas longer in the elderly group. We conclude that as there isa risk of prolonged effect of vecuronium in the elderly, monitoringof neuromuscular function is recommended in this group. Alternatively,atracurium should be preferred for prolonged surgery in elderlypatients.     

Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA Supreme™ and the ETT

Background: We designed a prospective randomized single‐blind study to compare efficiency and post‐operative upper airway morbidity when the laryngeal mask airway (LMA) Supreme^? is used as an alternative to the endotracheal tube (ETT). Methods: One hundred and thirty‐eight elective pelvic laparoscopic ASA I–II female patients were assigned to receive either the LMA Supreme^® or the ETT for airway management. Balanced anesthesia and ventilation techniques were standardized to control end‐tidal CO₂ and BIS value in the range 4.5–5 kPa and 40–50, respectively, and to maintain adequate hemodynamic stability. A single surgeon blinded to the airway management technique performed all surgical procedures. The ventilation efficiency of each airway was evaluated. Anesthesia‐ and surgery‐related times were calculated and anesthesia details were recorded. Post‐operative pain and pharyngolaryngeal morbidity were measured in a blind fashion using a numerical rating scale (NRS) (0–100). Results: Surgery duration was similar in both groups. Airway management duration was shorter with the LMA Supreme^®. Post‐operative pharyngolaryngeal morbidity incidence and all symptoms' intensity were significantly increased after ETT as compared with LMA Supreme^® anesthesia. At the end of the PACU stage, the incidence and mean NRS of post‐operative hoarseness were reduced when LMA Supreme^® was used as an alternative to the ETT (16% vs. 47%; P<0.01 and 9 vs. 19, P<0.01, respectively). Conclusion: We demonstrated that choosing an LMA Supreme^® was an efficient pharyngolaryngeal morbidity‐sparing strategy. Moreover, we showed that the LMA Supreme^® and the ETT were equally effective airways for a routine gynecological laparoscopy procedure.