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Heijkoop B, Lahoud J, Wong ELH. Endoscopic stone management in an ectopic ureter inserting into the prostatic urethra. BMJ Case Rep 2023; 16:e254927. [PMID: 37770237 PMCID: PMC10546127 DOI: 10.1136/bcr-2023-254927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
We report a case of successful endoscopic stone management in a patient with ectopic ureteric insertion. The patient had a complete duplex collecting system, with the upper moiety ureter inserting ectopically into his prostatic urethra, and an obstructing ureteric stone in the distal portion of the ectopic ureter. This made both characterisation of the patient's anatomy and initial emergency stone management challenging.The case offers several learning points for clinicians who may encounter similar situations. By describing the challenges of managing this patient's presentation, we highlight considerations in imaging interpretation and operative approach that may help the reader manage a similar presentation to their practice. Additionally, we remind the urologist to consider the implications of an ectopic duplex ureter on future procedures, such as transurethral resection of the prostate or radical prostatectomy.
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Affiliation(s)
- Bridget Heijkoop
- Urology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Urology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - John Lahoud
- Urology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Eddy Lee Hao Wong
- Urology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Urology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
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Williams ISC, Lahoud J, Gurney H, Arasaratnam M, Patel MI. Outcomes of retroperitoneal lymph node dissection for testicular cancer by a high volume surgeon from Australia: a case for centralisation. ANZ J Surg 2021; 92:1044-1049. [PMID: 34724334 DOI: 10.1111/ans.17323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are few studies examining retroperitoneal lymph node dissection (RPLND) for testicular cancer in Australia. This study examines the perioperative outcomes, complications and survival rates following RPLND, by a high volume, single surgeon. METHODS A retrospective, case series of a single surgeon, multi-centre study included all patients who underwent RPLND following testicular cancer at Westmead Public Hospital, Westmead Private Hospital, and Macquarie University Hospital 2005-2020. One hundred one patients identified, with 94 having sufficient available data. RESULTS At time of operation, median age was 29.5 years. 84.2% had T1 or T2 primary tumours at diagnosis. Most common RPLND indication was residual mass post-chemotherapy (92.6%), with bleomycin, etoposide and cisplatin (BEP)x3 and BEPx4 most common chemotherapy regimens (50% and 35% respectively). Post-chemotherapy, largest residual mass ranged from 0.9 to 20 cm (median 3.32 cm). Post-chemotherapy, 95.7% masses were found in retroperitoneum (64.4% para-aortic region). 93.6% had open approach. 42.5% had bilateral nerve sparing. Majority (97.1%) did not require blood transfusion. No complications reported in 52.1% of patients. No deaths recorded within 90 days of surgery. At time of analysis, 91.5% had recurrence free survival, and 92.6% overall survival, at a median follow-up since surgery of 47.5 months (range 11 to 200 months). CONCLUSIONS This retrospective study, addressing peri-operative surgical outcomes for RPLND surgery in Australia, is comparable to high-volume international urological centre studies, and shows that centralisation of post-chemotherapy RPLND to an experienced surgeon, results in low perioperative morbidity and mortality.
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Affiliation(s)
| | - John Lahoud
- Specialty of Surgery, University of Sydney, Sydney, Australia
| | - Howard Gurney
- Department of Medical Oncology, Westmead Hospital, Sydney, Australia
| | | | - Manish I Patel
- Specialty of Surgery, University of Sydney, Sydney, Australia.,Department of Urology, Westmead Hospital, Westmead, Australia
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Lahoud J, Fong V, Rajendran S, Tse V. Desmoid fibromatosis involving the ureter: A rare presentation with intraoperative challenges. Urol Case Rep 2021; 40:101883. [PMID: 34712580 PMCID: PMC8528671 DOI: 10.1016/j.eucr.2021.101883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 10/26/2022] Open
Abstract
Following failed retrograde and antegrade ureteric stenting, a 35-year-old male patient underwent an elective boari flap for marked proximal hydroureteronephrosis due to a periureteric mass in the right iliac fossa. Intraoperative vascular surgical assistance was required for control of arterial bleeding due to friable vessel wall. Histopathology demonstrated desmoid fibromatosis.
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Affiliation(s)
- John Lahoud
- Department of Urology, Concord Hospital, Sydney, Australia
| | - Voon Fong
- Department of Urology, Concord Hospital, Sydney, Australia
| | | | - Vincent Tse
- Department of Urology, Concord Hospital, Sydney, Australia
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4
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Doan P, Graham P, Lahoud J, Remmers S, Roobol MJ, Kim L, Patel MI. A comparison of prostate cancer prediction models in men undergoing both magnetic resonance imaging and transperineal biopsy: Are the models still relevant? BJU Int 2021; 128 Suppl 3:36-44. [PMID: 34374190 DOI: 10.1111/bju.15554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To externally validate and compare the performance of the European Randomized Study of Screening for Prostate Cancer risk calculator 3/4 (ERSPC-RC3/4), the Prostate Biopsy Collaborative Group risk calculator (PBCG-RC) and the van Leeuwen model to determine which prediction model would perform the best in a contemporary Australian cohort undergoing transperineal (TP) biopsy. MATERIALS AND METHODS A retrospective review identified all patients undergoing TP biopsy across two centres. Of the 797 patients identified, 373 had the data required to test all three risk calculators. The probability of high-grade prostate cancer, defined as International Society of Urological Pathology Grade Group >1, was calculated for each patient. For each prediction model discrimination was assessed using area under the receiver-operating characteristic curve (AUC), calibration using numerical and graphical summaries, and net benefit using decision curve analysis. RESULTS Assessment of model discrimination for detecting high-grade prostate cancer showed AUCs of 0.79 (95% confidence interval [CI] 0.74-0.84) for the ERSPC-RC3/4, 0.81 (95% CI 0.77-0.86) for the van Leeuwen model, and 0.68 (95% CI 0.63-0.74) for the PBCG-RC, compared to 0.58 (95% CI 0.52-0.65) for prostate-specific antigen alone. The ERSPC-RC3/4 was the best calibrated in the moderate-risk range of 10-40%, whilst the van Leeuwen model was the best calibrated in the low-risk range of 0-10%. The van Leeuwen model demonstrated the greatest net benefit from 10% risk onwards, followed closely by the ERSPC-RC3/4 and then the PBCG-RC. CONCLUSION The ERPSC-RC3/4 demonstrated good performance and was comparable to the van Leeuwen model with regard to discrimination, calibration and net benefit for an Australian population undergoing TP prostate biopsy. It is one of the most accessible risk calculators with an easy-to-use online platform, therefore, we recommend that Australian urologists use the ERSPC-RC3/4 to predict risk in the clinical setting.
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Affiliation(s)
- Paul Doan
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | - Petra Graham
- Macquarie Business School, Macquarie University, Sydney, NSW, Australia
| | - John Lahoud
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | | | | | - Lawrence Kim
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia.,Specialty of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia.,Specialty of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Lahoud J, Doan P, Kim L, Patel MI. Perilesional Biopsies Increase Detection of Significant Prostate Cancer in Men with PI-RADS 4/5 Lesions: Validation of the PI-RADS Steering Committee Recommendation. Eur Urol 2021; 80:260-261. [PMID: 33593652 DOI: 10.1016/j.eururo.2021.01.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Affiliation(s)
- John Lahoud
- Department of Urology, Westmead Hospital, Westmead, Australia
| | - Paul Doan
- Department of Urology, Westmead Hospital, Westmead, Australia
| | - Lawrence Kim
- Department of Urology, Westmead Hospital, Westmead, Australia; Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Westmead, Australia; Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia.
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Doan P, Lahoud J, Kim L, Patel MI. Identifying prostate cancer in men with non-suspicious multi-parametric magnetic resonance imaging of the prostate. ANZ J Surg 2021; 91:578-583. [PMID: 33475230 DOI: 10.1111/ans.16583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/30/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND To formulate clinical pathways for identifying clinically significant prostate cancer (csPC) and avoiding insignificant prostate cancer (isPC) in those without suspicious regions of interest on multi-parametric magnetic resonance imaging (mpMRI) of the prostate. METHODS A retrospective review identified patients with negative mpMRI who underwent subsequent transperineal prostate biopsy across two centres. Patient characteristics and association with biopsy results were evaluated using univariate and multivariate regression analyses. RESULTS A total of 144 patients were identified as having negative mpMRI and undergoing subsequent transperineal prostate biopsy; 18% (25/144) of the cohort were found to have csPC. Logistic regression analysis failed to identify statistically significant predictive factors. In this cohort, if all patients with prostate-specific antigen > 3.0 were biopsied the least amount of csPC is missed, at 20% (5/25) however all isPC would be diagnosed. The least amount of isPC is diagnosed with a biopsy threshold of >15% from the European Randomized Study of Screening for Prostate Cancer calculator with 20% (5/25) of isPC diagnoses made however only 10.5% (2/19) csPC would be diagnosed. A biopsy threshold of >5% risk reduces the number of csPC missed to 37% (7/19) however increases isPC diagnoses to 54% (13/24) of the population. CONCLUSION False-negative rates of prostate MRI for csPC are significant within our cohort at 18%. The decision to biopsy should be made in conjunction with a risk profile acceptable by the patient and clinician. The current study demonstrates that there is a need to balance the risk of missing csPC and harm of diagnosing isPC.
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Affiliation(s)
- Paul Doan
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia
| | - John Lahoud
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lawrence Kim
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Lahoud J, Doan P, Kim LH, Patel MI. Transperineal systematic biopsies in addition to targeted biopsies are important in the detection of clinically significant prostate cancer. ANZ J Surg 2021; 91:584-589. [PMID: 33400371 DOI: 10.1111/ans.16524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study aimed to determine whether the addition of transperineal systematic biopsies (SB) to targeted biopsies (TB) improved clinically significant prostate cancer (csPC) detection rates without high increase in insignificant prostate cancer detection rates in an Australian population. METHODS In this retrospective review, a total of 254 patients who had a Prostate Imaging-Reporting and Data System score between 3 and 5, and a transperineal TB and SB between 2014 and 2019 from two centres were included in this study. The primary outcome of this study was to determine csPC rates on TB and SB. The secondary outcome was a comparison of the Gleason Grade Group between TB and SB. csPC was defined as an International Society of Urological Pathology Gleason Grade Group of 2 or greater. RESULTS SB alone detected more csPC overall compared to TB (152/254 (60%) versus 128/254 (51%), respectively). An additional 40 of 254 (16%) csPC cases were diagnosed with the addition of SB. Furthermore, the cost of diagnosing insignificant prostate cancer by SB when TB were negative was an additional 13/254 (5.1%). CONCLUSION A combination of TB and SB provides the best outcomes for detecting csPC and is especially warranted for patients with a higher Prostate Imaging-Reporting and Data System score on multiparametric magnetic resonance imaging.
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Affiliation(s)
- John Lahoud
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Paul Doan
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Lawrence H Kim
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Hindmarch J, Bazzi K, Lahoud J, Malik A, Sinha S. Evaluating a low-fidelity inguinal canal model. Surg Radiol Anat 2020; 42:1323-1328. [PMID: 32844300 DOI: 10.1007/s00276-020-02553-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The inguinal canal anatomy is of paramount clinical significance due to the common occurrence of direct and indirect inguinal hernias. However, the inguinal canal is often an area of great difficulty for medical students to understand. The aim of this study was to evaluate the use of a low-cost, low-fidelity inguinal canal model as a teaching and learning aid. METHODS A low-fidelity inguinal canal model was introduced as a learning aid in an anatomy tutorial on the inguinal region. Students were randomised into intervention (n = 66) and control (n = 40) groups. Following the tutorial, all students completed a multiple-choice question quiz on the inguinal canal. The intervention group also completed a questionnaire evaluating the positive and negative aspects of the model. RESULTS Students taught with the inguinal canal model achieved higher scores (mean: 88.31% vs 81.7%, p = 0.087). Positive aspects of the model as described by the students included its simplicity and ability to improve their three-dimensional understanding of the inguinal canal. Students requested more hands-on time with the model during the tutorial. CONCLUSION The present study supports current literature in that low-fidelity anatomy models are a useful adjunct to aid students' learning of complex anatomical concepts. Students may benefit from creating their own inguinal canal model to retain as a personal study tool.
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Affiliation(s)
- Jake Hindmarch
- Department of Anatomy, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Khalil Bazzi
- Department of Anatomy, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, Sydney, NSW, 2010, Australia
| | - John Lahoud
- Department of Anatomy, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Ali Malik
- Department of Anatomy, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Sankar Sinha
- Department of Anatomy, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, Sydney, NSW, 2010, Australia.,Department of Surgery, University of Tasmania, Hobart, TAS, Australia
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Lahoud J, Bazzi K, Waters E, Clyne P, Sinha SN. Team‐based anatomy learning for medical students: preparing tomorrow's surgeons. ANZ J Surg 2019; 89:628-629. [DOI: 10.1111/ans.15156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- John Lahoud
- School of Medicine, Department of AnatomyUniversity of Notre Dame Australia Sydney New South Wales Australia
| | - Khalil Bazzi
- School of Medicine, Department of AnatomyUniversity of Notre Dame Australia Sydney New South Wales Australia
| | - Edward Waters
- School of Medicine, Department of AnatomyUniversity of Notre Dame Australia Sydney New South Wales Australia
| | - Peter Clyne
- School of Medicine, Department of AnatomyUniversity of Notre Dame Australia Sydney New South Wales Australia
| | - Sankar N. Sinha
- School of Medicine, Department of AnatomyUniversity of Notre Dame Australia Sydney New South Wales Australia
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Lahoud J, Bazzi K, Yeo D, Carey S. Survey of nutritional practices in total gastrectomy and oesophagectomy procedures. Nutr Diet 2018; 76:135-140. [DOI: 10.1111/1747-0080.12447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022]
Affiliation(s)
- John Lahoud
- School of MedicineThe University of Notre Dame Australia Sydney New South Wales Australia
| | - Khalil Bazzi
- School of MedicineThe University of Notre Dame Australia Sydney New South Wales Australia
| | - David Yeo
- Department of Hepatobiliary and Upper Gastrointestinal SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
- Institute of Academic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Sharon Carey
- Department of Nutrition and DieteticsRoyal Prince Alfred Hospital Sydney New South Wales Australia
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Abstract
To compare the ability of equipotent doses of neostigmine, pyridostigmine and edrophonium to antagonize intense pancuronium neuromuscular blockade, one hundred and twenty ASA physical status I or II patients scheduled for elective surgery received 0.06 mg.kg-1 pancuronium during a thiopentone nitrous oxide-enflurane anaesthetic. Train-of-four stimulation was applied every 12 s and the force of contraction of the adductor pollicis muscle was recorded. In the first 60 patients, spontaneous recovery was allowed until ten per cent of initial first twitch height. Then neostigmine (0.005, 0.01, 0.02 or 0.05 mg.kg-1), pyridostigmine (0.02, 0.04, 0.1 or 0.2 mg.kg-1), or edrophonium (0.1, 0.2, 0.4 or 1 mg.kg-1) was injected by random allocation. Dose-response relationships were established from the measurement of first twitch height (T1) ten minutes later. From these, neostigmine, 0.04 and 0.08 mg.kg-1 was found to be equipotent to pyridostigmine, 0.2 and 0.38 mg.kg-1, and edrophonium, 0.54 and 1.15 mg.kg-1, respectively. These doses were given by random allocation to the next 60 patients, but at one per cent spontaneous recovery. Neostigmine, 0.04 mg.kg-1, produced a T1 of 73 +/- 4 per cent (mean +/- SEM), and a train-of-four ratio (TOF) of 39 +/- 3 per cent. This was significantly greater than with pyridostigmine, 0.2 mg.kg-1 (T1 = 50 +/- 6 per cent; TOF = 25 +/- 3 per cent), and edrophonium, 0.54 mg.kg-1 (T1 = 54 +/- 3 per cent; TOF = 17 +/- 2 per cent).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Donati
- Department of Anaesthesia, Royal Victoria Hospital, Montreal, Quebec
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Donati F, Lahoud J, Walsh CM, Lavelle PA, Bevan DR. Onset of pancuronium and d-tubocurarine blockade with priming. Can Anaesth Soc J 1986; 33:571-7. [PMID: 3021300 DOI: 10.1007/bf03014262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The synergistic effect of pancuronium bromide (PCB) and d-tubocurarine (DTC) on the onset time of neuromuscular blockade was tested in 108 ASA physical status I and II adults anaesthetized with thiopentone, nitrous oxide and halothane. Either saline or a small (priming) dose (DTC, 0.04 mg X kg-1, or PCB, 0.007 mg X kg-1) was administered 3 min before a paralyzing dose of either DTC or PCB. The total dose of relaxant was equivalent to DTC, 0.4 mg X kg-1, or PCB, 0.07 mg X kg-1. Neuromuscular activity was measured using train-of-four stimulation applied every 12 s. Time to 50 per cent first twitch blockade was 63 +/- 4.6 s (mean +/- SEM) with DTC and 88 +/- 5.2 s with PCB (p less than 0.002). Times to 90 per cent blockade were not different between the two drugs (161 +/- 20 s and 141 +/- 21 s respectively). Priming a DTC blockade with either DTC or PCB or priming a PCB blockade with PCB produced an acceleration of less than 10 s at all levels of blockade. Compared with PCB alone, priming PCB blockade with DTC reduced the time to 50 per cent blockade to 71 +/- 4.5 s (p less than 0.02) and to 90 per cent blockade to 111 +/- 8 s (p less than 0.05). Priming did not affect the duration of action significantly, except in the case of PCB priming of DTC, where duration was increased from 39 +/- 4.4 to 57 +/- 4 min (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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