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    Effect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block in patients undergoing lower abdominal surgery
    (Australian Soc Anaesthetists, 2011) Sahin, S. H.; Colak, A.; Sezer, A.; Arar, C.; Sevdi, S.; Gunday, I.; Sut, N.
    The aim of this study was to evaluate the effect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block. Ninety patients undergoing lower abdominal surge, were randomised into two groups after an epidural test dose: the epidural group (n=45) received a bolus of 15 nil of 0.5% levobupivacaine whereas the control group (n=45) did not. Anaesthesia was induced and maintained with propofol, fentanyl, vecuronium and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg/kg and monitored with acceleromyographic train-of-four at the adductor pollicis. Patients in each group received neostigmine at 25% recovery of the first twitch of train-of-four during recovery from anaesthesia. The effect of epidural levobupivacaine on the speed of recovery of neuromuscular function was evaluated. The lag time, onset time and time from vecuronium administration until 25% T1 recovery did not differ between the groups. The times of the recovery index (the time from 25% to 75% recovery of T1) and of the DUR 25-train-of-four 90 (time from 25% T1 to train-of-four ratio of 0.9) in the epidural group were significantly longer than those for the control group (5.2 [2.1] vs 3.04 [1.02] minutes and 10.8 [3.3] vs 8.2 [2.3] minutes, P < 0.001). This study shows that epidural levobupivacaine significantly delays the train-of-four recovery from vecuronium-induced block. Although the interaction is small in the clinical setting, anaesthetists should take this interaction into consideration when combining general and epidural anaesthesia during surgery.
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    The use of esmolol and magnesium to prevent haemodynamic responses to extubation after coronary artery grafting
    (Lippincott Williams & Wilkins, 2007) Arar, C.; Colak, A.; Alagol, A.; Uzer, S. S.; Ege, T.; Turan, N.; Duran, E.
    Background and Objective: The haemodynamic responses during extubation can cause complications after openheart surgery. In this study, we aimed to examine the effect of esmolol and magnesium before extubation on these haemodynamic responses. Methods: Following the approval of local Ethics Committee, 120 patients having coronary artery bypass grafting with extubation in the intensive care unit were included in the study. Patients were allocated to receive esmolol 1 mg kg(-1) (group 1, n = 40), magnesium 30 mg kg(-1) (Group 11, n = 40) or normal saline (Group 111, n = 40). Study medication was administered as a 20-min infusion in a volume of 20 mL. Patients were extubated just after termination of the infusion. Heart rate, blood pressure and central venous pressure were recorded prior to drug administration, before extubation, during extubation and I min after extubation. Results: Heart rate was lower in Group I than in Groups 11 (P < 0.05) and III (P < 0.001) and lower in Group 11 than in Group III (P < 0.05) during extubation. It was also lower in Group I than in Group III (P < 0.05) after extubation. Systolic blood pressure was lower in Group I than in Groups 11 and III (P < 0.001) during extubation. Diastolic blood pressure was higher in Group III than in Groups I and 11 during extubation (P < 0.001) and after extubation (P < 0.05). Mean arterial pressure was lower in Group I than in Groups 11 and III (P < 0.001) during extubation, lower in Group III than in Group III (P < 0.05) during extubation and lower in Group I than in Group III (P < 0.05) after extubation. Conclusion: We found that using esmolol before extubation following coronary artery bypass graft surgery prevents undesirable haemodynamic responses while magnesium reduces undesirable haemodynamic responses but does not prevent them.