The analgesic efficacy and safety of tramadol and morphine were compared in a double-blind, randomized study of 150 female patients after gynecologic surgery. As required, patients could receive up to three intravenous doses of either 50 mg of tramadol or 5 mg of morphine within a period of 6 h. Pain intensity (verbal response score) was recorded before injection and at 0.5, 1, 2, 3, 5, and 6 h after the initial dose; at these times, pain relief was also assessed. Oxygen saturation was monitored continuously by pulse oximetry for at least 30 min after each injection. In 13.3% of the morphine group (but in none of the tramadol group) transcutaneous pulse oxygen saturation decreased to less than 86%; in 50% of these patients the decrease occurred after only the first 5 mg of morphine. Both drugs produced acceptable analgesia, and there were no clinically significant adverse events. In demonstrating the absence of clinically relevant respiratory depression with tramadol, we underline its safety for postoperative pain relief.
This first randomized controlled multicenter trial on the use of xenon as an inhalational anesthetic confirms, in a large group of patients, that xenon in oxygen provides effective and safe anesthesia, with the advantage of a more rapid recovery when compared with anesthesia using isoflurane-nitrous oxide.
We determined the forces on the maxillary incisors during routine laryngoscopy in 65 adult patients. The forces were measured by a strain gauge based sensor positioned between the handle and the blade of the laryngoscope. The mean maximal force acting on the maxillary incisors was 49 N . In patients without maxillary incisors, the force acting on the gums was signiJcantly lower at 21 N (p < 0.001). These results suggest that, despite traditional advice to the contrary, a levering movement of the laryngoscope, using the maxillary incisors (or gums) as a fulcrum, is common practice. Biomechanical analysis revealed that, although levering is not the preferred movement, it is an eficient way of bringing the glottis into view. These results may have implications for future laryngoscope design. Key wordsEquipment; laryngoscope.The Macintosh laryngoscope has proved itself over half a century and is still one of the most popular laryngoscopes [I]. Even in experienced hands, however, complications can occur, notably damage to the maxillary incisors (MI) [2,3]; damage to teeth is reported to be the most common single reason for complaints against anaesthetists [4]. Because such damage is the result of contact between the laryngoscope blade and the teeth, the design and manipulation of the blade has a major influence on the risk of this type of morbidity [S]. Until now, this aspect of laryngoscopy has been based on subjective and empirical criteria; detailed evaluation of the laryngoscopy technique has not been possible [6]. To assist the rational development and use of laryngoscopes, an understanding of the forces involved is essential. This, in turn, is o d y possible through study of a biomechanical model followed by objective measurements. Although we realise that our knowledge of the biomechanics of laryngoscopy is limited, the current methods are inadequate for quantifying the forces generated during laryngoscopy in clinical practice.In recent years, various sensors have been described for the measurement of forces applied to the tongue during laryngoscopy [7,9]. Clearly, accurate quantification of other forces present offers the possibility of better laryngoscope design, technique and testing. At present the contact between the laryngoscope blade and the teeth can only be assessed by direct observation. It is said that, to minimise the pressure on the teeth, the blade of the laryngoscope should be lifted upward and forward along the axis of the handle and rotation should be avoided [3, lo]. However, the biomechanical basis of these recommendations is poor. Measurement of the forces acting on the teeth is essential to identify the cause and prevention of damage.In this paper we present a new technique for the measurement of forces on the maxillary incisors during laryngoscopy. This is based on a modification of a strain gauge sensor described previously [8]. The aim of this study was to quantify these forces and, if possible, improve our understanding of the mechanics of laryngoscopy.
The neuromuscular blocking effects of the new monoquaternary analogue of pancuronium, Org NC 45, have been investigated in anaesthetized patients. In different doses administered as a single i.v. bolus or as an initial bolus followed by several small maintenance doses or by a continuous infusion. Org NC 45 appears to be approximately as potent as pancuronium, but has a more rapid onset of action, considerably shorter duration of action and faster recovery rate than pancuronium. It showed no cumulative effects even after 10 maintenance doses were injected in succession. Doses of 0.08 mg kg-1 provided ideal intubating conditions in 90--95 s. Infusions of Org NC 45 provided much smoother control of neuromuscular blockade than did pancuronium. No cardiovascular side-effects were noted even at the greatest dose (0.12 mg kg-1) used. Org NC 45 has clear advantages over pancuronium and represents a potentially valuable addition to the armamentarium of clinically useful muscle relaxants.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.