We have studied, in 150 patients undergoing elective oral surgery, the effectiveness and sequelae of pretreatment with rocuronium for reducing myalgia after suxamethonium. Patients were allocated randomly to one of three groups: anaesthesia was induced with propofol and fentanyl, and group V received vecuronium 1 mg, group R rocuronium 6 mg and group P placebo pretreatment. Suxamethonium 1.5 mg kg-1 was given 60 s after the pretreatment agent. All patients received ketorolac 10 mg i.v. and morphine 10 mg i.m. for analgesia. The incidence of postoperative myalgia on day 1 after rocuronium (20%) was significantly less than after vecuronium (42%) (P < 0.05) or placebo (70%) (P < 0.01). By day 4 the incidence of myalgia was 28.6% in the rocuronium group, 46.3% in the vecuronium group and 95% in the placebo group. Intubating conditions were not affected adversely by any pretreatment regimen.
In human volunteers, the response times of 11 pulse oximeters to a 10% step reduction in arterial oxygen saturation were measured using an acute decompression technique. When finger probes were used, nine oximeters had similar response times and two were significantly slower (P less than 0.05). The ear probe response time was similar on six oximeters assessed, and faster than the finger probes. The response times of the oximeters to an acute increase in arterial saturation were tested by suddenly changing the inspired gas from air to 100% oxygen at an ambient pressure of 380 mm Hg. For ear probes, the response times were similar for all oximeters; for finger probes, three fast-responding and three slow-responding oximeters were identified (P less than 0.05). A faster response could be elicited by placing the probes on the thumb (P less than 0.05). We conclude that if a rapid indication of changes in arterial saturation is required, pulse oximeters with ear probes should be used. If finger probes are used, they should be placed on the thumb. The oximeter used will influence the response time if finger probes are used, but it will have little effect if ear probes are used.
The purpose of the study was an accurate and comprehensive prospective analysis of all untoward anaesthetic events and their sequelae, within a general hospital over a period of 1 year. We identified five system sets into which each of these critical incidents could be categorised. We also recorded data pertaining to the severity of the disturbance or event, the monitor that first identified the problem and the affect, if any, of the incident upon the patient. We found a critical incident rate of 6.68%, or one in 15 anaesthetic procedures performed. By far the majority of incidents were rapidly detected and effectively managed, with a morbidity rate of only 0.53%. The application of minimum monitoring standards was strongly reinforced. The presence of an anaesthetist throughout the period of the whole anaesthetic was shown to be the most effective component of these standards. The audit identified a trend for junior anaesthetists in particular to have a higher incidence of problems with the airway and circulation and for these to be associated with increased morbidity. This prompted revised supervision and training strategies for our junior anaesthetists.
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