[High-dose vecuronium in "open-eye" emergency surgery].
BACKGROUND
Succinylcholine is contraindicated in "open eye" surgery because it raises intraocular pressure. High dose vecuronium reduces onset time for orothracheal intubation. The objective of the study was to evaluate clinical efficacy of high dose vecuronium (0.2 and 0.3 mg/kg) and its effects on intraocular pressure for its use in "open eye" emergency surgery.


METHODS
Randomized, prospective, clinical trial.


METHODS
Eye clinic of University of Florence.


METHODS
40 patients scheduled for vitrectomy, excluding any drug action on IOP, subdivided into two groups: the first (20 patients) had 0.2 mg/kg vecuronium at the induction of anaesthesia, the second (20 patients) 0.3 mg/kg. ANAESTHESIA: Premedication: atropine 0.01 mg/kg. Preinduction: fentanyl 3 micrograms/kg. Induction: thiopentone 4 mg/kg+ after 1 minute) vecuronium. Orotracheal intubation after 90".


METHODS
IOP was obtained by applanation tonometry in three time: T0 = preinduction; T1 = 50" after thiopentone; T2 = 50" after vecuronium. Systodiatolic pressure was obtained at the same time. Neuromuscular function was evaluated by vocals cord relaxation and by clinical evaluation of response to ulnar nerve stimulation (by train of four).


METHODS
"t"-Student.


CONCLUSIONS
No modification of IOP and systodiastolic pressure was caused by administration of vecuronium; no statistic differences are between T1 and T2 values. All patients were intubated after 90" vecuronium administration; the vocal cord relaxation was maxima in all the patients. High dose vecuronium seems to be useful in "open eye" emergency surgery when succinylcholine is contraindicated.
Di Filippo
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Istituto di Anestesiologia e Rianimazione, Università degli Studi, Firenze.
Grechi
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D000328:Adult; D004630:Emergencies; D005128:Eye Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D014673:Vecuronium Bromide / Q000008:administration & dosage*; D014821:Vitrectomy / Q000379:methods
D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide
Il vecuronio ad alti dosaggi nella chirurgia oftalmica di urgenza ad "occhio aperto".