We have assessed neuromuscular block electromyographically at the gastrocnemius muscle and compared it with that at the abductor digiti minimi muscle in 60 adult patients undergoing cervical spine surgery under general anaesthesia. All patients were in the prone position. After vecuronium 0.2 mg kg-1, times to onset of neuromuscular block at the gastrocnemius and abductor digiti minimi muscles were mean 147 (SD 24) and 145 (14) s, respectively (ns). Times to return of the first response of the post-tetanic count (PTC1) at the gastrocnemius and abductor digiti minimi muscles were 27.7 (5.6) and 37.0 (5.9) min, respectively (P = 0.0001). Times to return of the first response of the train-of-four (TOF) at the gastrocnemius and abductor digiti minimi muscles were 41.0 (9.1) and 49.9 (8.7) min, respectively (P = 0.01). Recovery of PTC, T1/T0 and TOF ratio at the gastrocnemius muscle were significantly faster than at the abductor digiti minimi muscle.

We have examined onset and recovery of neuromuscular block produced by vecuronium using either post-tetanic count (PTC), or the first twitch of the train-of-four (TOF) (T1/T0) and TOF ratio (T4/T1) during continuous infusion of nicardipine. Sixty adult patients were allocated to one of four groups of 15 patients each: nicardipine-PTC, nicardipine-TOF, control-PTC and control-TOF. In the nicardipine-PTC and nicardipine-TOF groups, nicardipine 0.03 mg kg-1 was given before vecuronium 0.1 mg kg-1 and a continuous infusion of nicardipine was started immediately at a rate of 2 micrograms kg-1 min-1. Mean time from administration of vecuronium to onset of neuromuscular block in the nicardipine-PTC and nicardipine-TOF groups was significantly shorter than in the control-PTC and control-TOF groups (166 (SD 39) vs 220 (28) s; P < 0.05). There was no significant difference in recovery of PTC between the nicardipine-PTC and control-PTC groups or in recovery of TOF ratio in the nicardipine-TOF and control-TOF groups. However, during recovery, T1/T0 in the nicardipine-TOF group was significantly less than that in the control-TOF group, 60-100 min after administration of vecuronium.

SummaryThe incidence and origin of contamination of the vocal cords in 53 trauma patients was studied when tracheal intubation was performed before hospital admission. Eighteen patients (34%) had gross contamination which was blood in 15 patients and gastric contents in three patients. This has implications for prehospital airway management and particularly for use of the laryngeal mask airway. Since victims of major trauma may have full stomachs and impaired airway reflexes they are assumed to be at high risk of large airway and pulmonary aspiration [1]. Both gastric contents and debris from the upper airway, particularly blood, may be aspirated. The actual incidence of aspiration in trauma patients is unknown. It is also unclear whether the risk of aspiration comes primarily from blood and debris from the upper airway or from gastric contents. Where the major risk lies has implications for airway management. We examined the incidence and nature of aspiration in a group of trauma patients. MethodsOver a 10-week period, we studied 53 consecutive adult patients with major trauma who required tracheal intubation before admission to hospital by members of the London Helicopter Emergency Medical Service (London HEMS). Four doctors and five paramedics were involved in the study. After each intubation was performed, the presence and nature of gross contamination of the vocal cords visible at direct larangoscopy was recorded. Patient age, sex, mortality, mechanism of injury, nature of injuries and Glasgow coma score (GCS) before intubation were recorded. The status of the person intubating (doctor or paramedic) was also recorded. Pathologists performing post-mortem examinations on patients who died within 4 h of injury were asked to look specifically for evidence and nature of pulmonary aspiration. ResultsThere were 42 males and 11 females. The mean age of the patients was 41 years (range 16-80 years). Twenty-one patients survived and 32 died. Of the nonsurvivors, 17 died within 4 h of injury. Forty-four patients (83%) had head injuries of which 32 were isolated, six head and chest and six head and multiple injuries. Twenty-nine patients had a GCS of 3 and 39 scored 8 or below. Twenty-nine patients sustained their injuries in road-traffic accidents (20 as pedestrians). Eleven were injured in falls from a height.Twenty patients (38%) were intubated by paramedics and 33 (62%) by doctors.Eighteen (34%) patients had evidence of gross contamination of the vocal cords at direct laryngoscopy. All 18 had head injuries and a GCS below 8. In 15 of these patients, the airway was contaminated with blood and, in three, by gastric contents. The results of post-mortem examinations on 10 of the 17 patients who died within the first 4 h were available to us. One confirmed aspiration of gastric contents seen at laryngoscopy, one confirmed aspiration of blood, seven confirmed that no aspiration had occurred and one showed no evidence of aspiration 1097ᮊ 1999 Blackwell Science Ltd where a moderate amount of blood had been seen at intubat...

Aus der Zwiebel von Fritillaria verticillata, Wild. wurde von Yagil) friiher das Fritillin, ein kristallisiertes Alkaloid mit der Zusammensetzung C25H"NO3isoliert, das nach seinen Versuchen an Froschen and Kaninchen, wenn auch nicht gleiche, so doch sehr ahnliche Wirkungen wie das Veratrin besitzt. Aus derselben Droge gelang es neuerdings Fukud a2) zwei neue kristallisierte Alkaloide, das Verticin (013H33NO2 oder C79H35NO2) and das Verticillin (C19H33NO2) sowie ein amorphes, das Fritillarin (C19H33NO2) darzustellen. Da man erfahrungsgemass weiss, dass manche Alkaloide, die ein and derselben Pflanze entstammen, fast ausnahmslos in ihren pharmakologischen Wirkungen qualitativ ubereinstimmen and nur quantitativ von einander abweichen, so ist auch von diesen neuen Alkaloiden, schon bevor sie untersucht rind, zu erwarten, dass sie in ihren Wirkungen dem Fritillin qualitativ sehr nape stehen and quantitativ nicht nur von diesem, sondern auch untereinander wahrscheinlich verschieden sind. Um num festzustellen, inwieweit these Vermutung zutreffend ist, babe ich mit dem Verticin, Verticillin and Fritillarin Versuche an Froschen durchgefizhrt, deren Ergebnisse in der folgenden Arbeit mitgeteilt werden sollen. Bei dieser Gelegenheit mochte ich dem Herrn Privatdoz. Fukuda vom Chemischen Institut der hiesigen Universitat fur die freundliche Uberlassung der wertvollen Alkaloide meinen besten Dank aussprechen.

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