The effects of precurarization with a protective dose of d-tubocurarine in the conscious patient

Alfentanil as an adjuvant of balanced anaesthesia for tonsillectomy in adults

In a double-blind study, 80 adult patients, undergoing tonsillectomy, were randomly allocated to one of the four groups: d-tubocurarine (d-Tc) 50 micrograms/kg+alfentanil (Alf) 20 micrograms/kg, d-Tc 50 micrograms/kg+Alf 50 micrograms/kg, Alf 10 micrograms/kg+Alf 20 micrograms/kg, Alf 10 micrograms/kg+Alf 50 micrograms/kg. The first drug was given 2 min before thiopental and the second drug 1 min before inserting the mouth gag. Intubation was facilitated with suxamethonium. Anaesthesia was maintained with 70% nitrous oxide in oxygen and peripheral muscle relaxation during operation with vecuronium. For analysis of the induction characteristics, both d-Tc-pretreatment groups were treated together and compared with the results of the Alf-pretreatment groups. Muscle fasciculations occurred in 20% in the d-Tc group and in 70% in the Alf group. Neither d-tubocurarine nor alfentanil prevented the cardiovascular intubation response. Cardiovascular responses to the placement of the mouth gag occurred only in the lower-dose alfentanil groups. ECG changes during operation occurred in 25-45% of the patients. The most common ECG change was junctional rhythm. The operating conditions were good in 65-80% of the patients. The mean recovery score (0-10) ranged from 9.3 to 9.7 between the groups. The incidence of nausea ranged from 20-30% and that of vomiting from 10-25% between the groups. Bleeding from the operation site occurred in 20-30% of the patients. None of the patients needed sutures to stop the bleeding.

Effect of fazadinium (Fazadon) on muscle fasciculations induced by succinylcholine

The effects on muscle fasciculations and ease of tracheal intubation of pretreatment with fazadinium before administration of succinylcholine were evaluated in 85 patients. Four dose levels of fazadinium evaluated were 0.05 mg . kg-1, 0.075 mg . kg-1, 0.10 mg . kg-1 and 0.15 mg . kg-1. The 0.05 mg . kg-1 dose did not always prevent succinylcholine-induced muscle fasciculations. The 0.15 mg . kg-1 dose gave poor conditions for tracheal intubation and was therefore discontinued. The 0.075 mg . kg-1 dose seemed optimal. Most patients felt transient pain at the site of the injection during administration of fazadinium, and many had a sensation of drowsiness.

Awareness, muscle relaxants and balanced anaesthesia

The incidence of awareness during insufficient anaesthesia is reported to be one per cent. It is usually due to the use of muscle relaxants, a balanced technique and the lightest possible depth of anaesthesia. Increased incidences were noted in open-heart surgery, during intubation-endoscopy procedures and in caesarean delivery patients. Experiences of awareness are disturbing to patients, who are usually benefited by a sympathetic and forthright explanation of the event. Fourteen representative cases of the problem are reported. Since no adequate sign or test exists for detection of awareness during very light anaesthesia or with associated paralysis, more meticulous attention is required in using relaxants or the balanced technique. Greater anaesthetic supplementation and reduction in the use of relaxants are recommended to halt the recurrence of this most serious anaesthetic problem.