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We performed a randomized controlled trial of the effect of intravenous fluid preload on maternal hypotension and fetal heart rate (FHR) changes in labour after the first epidural injection. Group 1 (49 women) received 1 litre of crystalloid preload. Group 2 (46 women) received no preload. No statistically significant difference was shown between the two groups for either of the outcomes. Hypotension was found in three women in group 1 and five in group 2 (P = 0.4). Deterioration in FHR pattern was found in four women in group 1 and 11 in group 2 (P = 0.08). This study has not shown a significant increase in the incidence of hypotension when intravenous preload is omitted before epidural analgesia using a low concentration of bupivacaine during labour. Because of the clinical importance of the difference in the rate of FHR deterioration between the two groups, we continue to administer preload for high-risk cases.

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In a prospective randomized two center trial, short-term prophylaxis with cefuroxime (CFX) in 189 patients was compared with cefazolin (CFZ) in 196 patients submitted to elective cardiac surgery. A total of 3 g was administered over 24 h in both groups. One major adverse reaction with CFX was noted. Patients were prospectively screened by infectious disease nurses for surgical wound and secondary infections. Sternal wound infections occurred in eight patients treated with CFX and all were minor. One patient from this group eventually died of infectious causes. In the CFZ-treated patients two major and six minor wound infections occurred requiring extensive debridement in two. Secondary infections occurred less frequently in the CFX group (13.2 per 100) than in the CFZ group (16.8 per 100) with two infection-related deaths in the CFX and one in the CFZ group. The most commonly identified organisms were Staphylococcus aureus and a variety of gram-negative organisms. No major differences were observed between the CFX and CFZ groups. Short-term administration of 3 g CFZ or CFX in this study could not demonstrate the advantage of one of the antibiotics used over the other in terms of clinical outcome, incidence or site of infection or organisms identified. The 24 h administration of 3 g CFZ or CFX provided suboptimal prophylaxis for wound infection or secondary infections in patients undergoing elective open heart surgery.

Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgiaPurpose: To determine which non-depolarizing relaxant among d-tubocurarine, vecuronium, atracurium, mivacurium and rocuronium prevented muscular fasciculations and myalgia following succinylcholine. Methods: In this double blind randomized study, 120 female patients scheduled for laparoscopic procedures were studied. They were divided into six groups of 20 according to the non-depolarizing pretreatment used: NaCl 0.9%(control), 0.05 mg'kg -I d-tubocurarine, 0.01 mg'l~ I vecuronium, 0.05 mg'kg -I atracurium, 0.02 mg'kg -I mivacurium and 0.06 mg.kg -I rocuronium. Four minutes after the pretreatment, 1.5 mg.kg -I succinytcholine was injected. Side effects of the pretreatment, the presence and magnitude of fasciculations, the ease of tracheal intubation, myalgia I, 24 and 48 hr after surgery were observed. A Puritan Bennett Datex TM 221 NMT Relaxograph monitor was used to evaluate the neuromuscular block. Results: Muscle fasciculations were observed in 19 of the 20 patients in the control group and in 3 of the 20 patients in the rocuronium group, the best of the pretreatments in that aspect. Four patients in the mivacurium group were unable to sustain more than four seconds head-lift after pretreatment (P < 0.05). Tracheal intubation conditions were better and the onset of block was faster and longer after succinylcholine in the control group (P < 0.05). Myalgias were present in 71% of the patients 24 hr postoperatively and the frequency was not different among the groups. Conclusion: Among the pretreatments tested, 0.06 mg'kg -~ rocuronium was the best to prevent muscular fasciculations following succinylcholine injection. In the population studied, pretreatment did not prevent postoperative myalgia. Succinylcholine 1.5 mg-kg -~ was more effective without a non-depolarizing pretreatment. Objectif : D&erminer quel myorelaxant non d~polarisant, dont la d-tubocurarine, le v&uronium, I'atracurium, le mivacurium et le rocuronium, saura le mieux pr~venir ~les myofasciculations et les myalgies qui suivent I'utilisation de succinylcholine. M~thode : Dans cette &ude randomis~e en double insu, 120 patientes devant subir une I~aroscopie ont ~t~ &udi~es. Elles ont ~t~ r~parties en six groupes de 20 selon le pr&raitement non d~polarisant utilis~ : NaCl 0,9 % (t~moin), 0,05 mg'kg "~ de d-bubocurarine, 0,01 mg'kg -j de v&uronium, 0,05 mg'kg "~ d'atracurium, 0,02 mg'kg -I de mivacurium et 0,06 mg'kg "g de rocuronium. Quatre minutes apr~s le pr&raitement, on a administr~ par injection 1,5 mg'kg -~ de succinylcholine. Les effets secondaires du pr&raitement, la pr&ence et rintensit~ des fasciculations, I'aisance de I'intubation endotrach~ale, les myalgies I h, 24h et 48h post chirurgicales ont ~t~ collig&. Un moniteur Relaxographe 221 NMT de Datex | Puritan Bennet a ~t~ utilis~ pour quantifier le bloc neuromusculaire. l~.sultats : Des myofasciculations ont ~t~ observ&s chez 19 des 20 patientes du groupe t~moin et chez 3 des 20 patien...