Cisatracurium versus vecuronium: a comparative, double blind, randomized, multicenter study in adult patients under propofol/fentanyl/N2O anesthesia.

The aim of this study was to compare the time course characteristics of cisatracurium (C) and vecuronium (V) induced neuromuscular block (NMB) following multiple doses, allowing spontaneous complete recovery (SCRT) and evaluating the influence of age. Methods. Following institutional approval and signed informed consent, 177 adult ASA 1-2 patients were included in a randomized, double-blind, multicenter study under N20/02/fentanyl/propofol anesthesia. Muscle relaxation was induced with 0.15 mg/kg C or 0.l mg/kg V and was maintained with 0.03 mg/kg of C or 0.02 mg/kg of V injected at T1 25% recovery. Intubating conditions were assessed at 2 min after the initial dose. Time course of NMB was monitored using accelerography (Tofguard) of the adductor pollicis with train-of-four (TOF). Data were analyzed with parametric (Anova) and non parametric statistics (χ2, Kruskal Wallis). Results. Both drugs offered good/excellent intubating conditions: duration of action of NMB (mean values ± SD, minutes) were: dur25 first dose: V 38.20±13.2 vs C 51.5±11.3 (Por< 65 no differences were noted in the intervals studied following C, while all were longer following V. The duration of block of C was longer than V; the SCRT after the final dose of C was shorter than V albeit not significant. There was a clinically significant increase in duration of block and recovery time in elderly patients for V but not for C. Conclusion. C and V allow predictable NMB duration and spontaneous recovery even if administered in multiple repeated doses; but in elderly patients duration of block and recovery time is longer following Vecuroniu

[Anti-arrhythmic effects of cardioplegic myocardial protection].

Cardioplegia gave excellent results in a preliminary series of 33 cases in which it was used during surgery. The fact that a sinus rhythm was re-established at the end of extracorporeal circulation in patients in atrial fibrillation suggests that it exerts an antiarrhythmic action at the atrial a level

Italian Intersociety Recommendations (SIAARTI, SIMEU, SIS 118, AISD, SIARED, SICUT, IRC) on Pain Management in the Emergency Setting.

Pain is the primary reason for admission to the Emergency Department (ED). However, the management of pain in this setting is often inadequate because of opiophagia, fear of excessive sedation, and fear of compromising an adequate clinical assessment. METHODS: An intersociety consensus conference was held in 2010 on the assessment and treatment of pain in the emergency setting. This report is the Italian Intersociety recommendations on pain management in the emergency department setting. RESULTS: The list of level A recommendations includes: a) use of IV Acetaminophen for opioid sparing properties and reduction of opioid related adverse events; b) ketaminemidazolam combination preferred over fentanylmidazolam or fentanylpropofol in pediatric patients; c) boluses of ketamine IV (particularly in the population under the age of 2 years and over the age of 13) can lead to impairment of the upper airways, including the onset of laryngospasm, requiring specific expertise and skills for admi