Biomedical subjects

L Saarnivaara

Publications and source records attributed to L Saarnivaara.

At least 19 recordsLinked to original sources

PubMed2001

Sevoflurane mask induction of anaesthesia is associated with epileptiform EEG in children.

BACKGROUND: Sevoflurane inhalation induction of anaesthesia is widely used in paediatric anaesthesia. We have found that this method is frequently associated with epileptiform electroencephalogram (EEG) in adults, especially if controlled hyperventilation is used. METHODS: We assessed EEG during sevoflurane inhalation induction in 31 children, aged 2-12 yr. Anaesthesia was induced with 8% sevoflurane in O2 in N2O 1:2. The patients were randomized to undergo controlled ventilation (CV group), or to breathe spontaneously (SB group) for 5 min. EEG was recorded as were noninvasive blood pressure and heart rate (HR). EEG recordings were classified by a clinical neurophysiologist. RESULTS: Three different types of interictal epileptiform discharge were detected. Suppression with spikes (SSP) was found in 25% and 0% in the CV and SB groups, rhythmic polyspikes (PSR) in 44% and 20%, and periodic epileptiform discharges (PED) in 44% and 0% (P<0.01), respectively. The incidence of all different types of interictal epileptiform discharge (SSP+PSR+PED) was 88% and 20% (P<0.001), respectively. Epileptiform EEG was associated with increased heart rate and blood pressure during anaesthetic induction. CONCLUSION: Both ventilation modes produced epileptiform EEG. With controlled ventilation, epileptiform discharges were seen in 88% of children. This warrants further studies of the suitability of this induction type in general, and especially in children with epilepsy.

Anesthetics, Inhalation↗

PubMed2001

Comparison of alfentanil and morphine in the prehospital treatment of patients with acute ischaemic-type chest pain.

Patients with acute myocardial ischaemic pain would benefit from rapid pain relief. The clinical usefulness of alfentanil, which has a rapid onset of action, was therefore assessed as the initial pain relieving opioid in patients suffering from acute myocardial ischaemic pain. The effects of alfentanil were compared with those of morphine in the prehospital treatment of 40 haemodynamically stable patients suffering from acute ischaemic-type chest pain. After initial assessment, the patients were given either 0.5 mg alfentanil or 5 mg morphine intravenously in a randomized double-blind fashion. The dose was repeated 2 minutes later if severe pain persisted. Arterial pressure, heart rate, respiratory rate and pain expressed on a visual analogue scale was measured before and at 2, 4, 6, 10 and 15 minutes after administration of drugs. After randomization, four patients were excluded. Sixteen patients received alfentanil and 20 patients morphine. Pain relief was faster (p < 0.005) in the alfentanil group than in the morphine group. Alfentanil was found to provide effective analgesia during the follow-up period of 15 minutes. No haemodynamic or respiratory side effects occurred. It is concluded that alfentanil is an effective analgesic in the prehospital treatment of myocardial ischaemic pain.

Aged↗

PubMed2000

Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol.

BACKGROUND: Alfentanil-propofol combination provides adequate conditions for tracheal intubation without neuromuscular blocking drugs in most patients. Providing an option for intense opioid effect without compromising recovery after short operations, remifentanil might offer benefits over alfentanil, especially in ambulatory surgery. In this study intubating conditions after remifentanil-propofol were compared to those after alfentanil-propofol. METHODS: In a randomized, double-blind study 60 healthy patients were assigned to one of three groups (n=20). After intravenous atropine, remifentanil 3 or 4 microg kg(-1) (Rem3 or Rem4) or alfentanil 30 microg kg(-1) (Alf30) was injected over 30 s followed by propofol 2.5 mg kg(-1). Sixty seconds after the administration of propofol, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor on the basis of ease of ventilation, jaw relaxation, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff. RESULTS: Overall conditions at intubation were significantly (P<0.05) better, and the frequency of excellent conditions was significantly (P<0.05) higher in the Rem4 group compared with the Alf30 group. Intubation was judged to be impossible in 20%, 25% or 5% of the patients in the Alf30, Rem3 or Rem4 groups, respectively. No patient manifested signs of opioid-induced muscular rigidity. In terms of arterial pressures or heart rate, there were no differences between the groups. CONCLUSION: The best method was the combination of remifentanil 4 microg kg(-1) and propofol 2.5 mg kg(-1). This provided satisfactory intubating conditions in 93%, and prevented cardiovascular intubation response.

Adolescent↗

PubMed1999

Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults?

We have compared the analgesic and opioid sparing effect of three i.v. non-steroidal anti-inflammatory drugs with placebo in a randomized, double-blind, placebo-controlled study in 80 adult patients after elective tonsillectomy. A standard anaesthetic was used. After induction of anaesthesia, patients received ketoprofen 100 mg, diclofenac 75 mg or ketorolac 30 mg by i.v. infusion over 30 min. Patients in the placebo group received saline. Ketoprofen and diclofenac infusions were repeated after 12 h and ketorolac infusion at 6 h and 12 h. Oxycodone was used as rescue analgesic. Patients in the ketoprofen group requested 32% less opioid and patients in the diclofenac and ketorolac groups 42% less opioid than those in the placebo group (P < 0.05). There were one, two and six patients in the placebo, diclofenac and ketorolac groups, respectively, but none in the ketoprofen group, who did not request opioid analgesia during the study (P < 0.05, ketorolac vs placebo and ketoprofen). Visual analogue pain scores were similar in all groups. Visual analogue satisfaction scores were significantly higher in the diclofenac group compared with the placebo group. The incidence of nausea was 44-54%. There were no differences in the incidence of other adverse reactions. We conclude that all three non-steroidal anti-inflammatory drugs were superior to placebo after tonsillectomy.

Adolescent↗

PubMed1998

Comparison of subhypnotic doses of thiopentone vs propofol on the incidence of postoperative nausea and vomiting following middle ear surgery.

BACKGROUND: Middle ear surgery is associated with a high incidence of emetic sequelae and propofol has been reported to have antiemetic activity in subhypnotic doses. METHODS: In a double-blind, randomized study, the patients received either thiopentone 1.0 mg.kg-1 (n = 26) or 0.5 mg.kg-1 propofol (n = 26) at the end of middle ear surgery under isoflurane-N2O-fentanyl-vecuronium anaesthesia. Trained nurses, unaware of the group assignment, assessed postoperative nausea, retching and vomiting up to 24 h after the end of anaesthesia. Droperidol 10 micrograms.kg-1 was used as a "rescue" antiemetic. RESULTS: The main result was that the patient in the propofol group did not suffer from retching and vomiting (R&V) during the first 6 h, whereas these symptoms occurred in 46% (P < 0.001) of the patients in the thiopentone group. The patients in the propofol group needed significantly less droperidol during the first 24 h (mean number of doses 0.39 +/- 0.57 (SD)) than the patients in the thiopentone group (1.35 +/- 1.47, P < 0.005). Treatment with propofol was a predictor for lowered incidence of R&V, as well as male gender and negative history of motion sickness. CONCLUSION: Propofol at a subhypnotic dose of 0.5 mg.kg-1 provides prophylaxis against retching and vomiting for the first 6 h postoperatively after middle ear surgery. The incidence of nausea was not reduced by propofol.

Adult↗

PubMed1998

Effects of four anticholinesterase-anticholinergic combinations and tracheal extubation on QTc interval of the ECG, heart rate and arterial pressure.

BACKGROUND: Imbalance in cardiac sympathetic tone causes prolongation of the QTc interval of the ECG. On the other hand, impairment of the parasympathetic control of the heart rate caused by anticholinesterase-anticholinergic combinations might also affect the cardiac sympathetic tone and hence the QTc interval of the ECG. The main purpose of the present study was to compare the effects of four anticholinesterase-anticholinergic combinations used for the antagonism of the neuromuscular block on the QTc interval of the ECG, heart rate and arterial pressure. METHODS: Eighty-four ASA class I-II patients with a mean age of 32 to 37 yr undergoing otolaryngological surgery were randomly allocated to one of the following groups: neostigmine 40 microg/kg+glycopyrronium 8 microg/kg (Ne-Glyc), neostigmine 40 microg/kg+atropine 20 microg/kg (Ne-Atr), edrophonium 200 microg/kg+atropine 300 microg (Edr-Atr (1)), edrophonium 500 microg/kg+atropine 7 microg/kg (Edr-Atr (2)). QTc interval and heart rate were measured by a signal processing method based on an IBM/PC/xT-compatible microcomputer and arterial pressure with a sphygmomanometer at 1-min intervals up to 10 min after the injection of the drugs and immediately and 2 min after extubation. The ECG, lead II, was continuously recorded. Neuromuscular block was measured by a Datex relaxograph. RESULTS: In all groups, the most pronounced increase in both QTc interval, heart rate and arterial pressure occurred 1 min after the study drugs and immediately after extubation. In all groups, the mean QTc intervals at 1 and 2 min after the study drugs and after extubation were longer than the upper limit of the normal range (440 ms). Junctional rhythm occurred in 1 to 3 patients in all other groups with the exception of the Edr-Atr(1) group in which no cardiac arrhythmias occurred. At 1 min, the heart rate in the Ne-Atr group was at a significantly higher level than that in the Ne-Glyc group. From 3 to 6 min, the heart rate in the Edr-Atr(2) group and at 3 min in the Edr-Atr(1) group was at a lower level than the heart rate in the Ne-Glyc group. CONCLUSIONS: On the basis of the present results, anticholinesterase-anticholinergic combinations should be avoided in patients having a long QT interval syndrome or a prolonged QT interval from other causes. In addition, the cardiovascular stimulation caused by tracheal extubation should also be avoided in these patients.

Adult↗

PubMed1998

Effect of esmolol on the hemodynamic and electrocardiographic changes during laryngomicroscopy under propofol-alfentanil anesthesia.

Laryngomicroscopy is a short-lasting procedure, which causes considerable hemodynamic and ECG changes. Therefore it sets specific demands on anesthetic care. In this double-blind randomized work, we studied hemodynamic and ECG changes in patients during laryngomicroscopy in jet ventilation under propofol-alfentanil anesthesia with and without esmolol, a short-acting beta1-adrenergic receptor blocking agent. Forty ASA class I-II patients were allocated to receive either esmolol 1 mg.kg-1 + 200 micrograms.kg-1.min-1 (the esmolol group) or saline (the control group) (mean age +/- SD 36 +/- 12 yrs in the esmolol group and 39 +/- 9 yrs in the control group). The heart rate and arterial pressure were measured non-invasively and ECG was analyzed with the aid of a microcomputer. In the control group, neither the heart rate nor the QTc interval of the ECG did change significantly when compared with the baseline values. In the presence of esmolol, the heart rate decreased and the QTc interval shortened during the procedure. Arterial pressure increased in the control group, but not in the esmolol group, when compared with the baseline values. No cardiac arrhythmias occurred in either of the groups. On the basis of the present study, propofol-alfentanil anesthesia combined with esmolol is a satisfactory method to meet specific demands of laryngomicroscopy in young and middle-aged ASA I-II patients. However, a combination of propofol and esmolol showed a tendency to decrease both the heart rate and arterial pressure and a caution is necessary when the combination were used in elderly patients.

Adrenergic beta-Antagonists↗

PubMed1997

Effect of esmolol on the heart rate, arterial pressure and electrocardiographic changes during laryngomicroscopy.

BACKGROUND: Laryngomicroscopy causes considerable haemodynamic and ECG changes and therefore requires high doses of anaesthetic agents, which prolong recovery. In this double-blind randomized work, we studied the effect of esmolol, a short-acting beta-adrenergic receptor-blocking agent, on haemodynamic and ECG changes during laryngomicroscopy under thiopental-alfentanil-isoflurane-suxamethonium anaesthesia. METHODS: Forty ASA class I-II patients (mean age 43 +/- 11 yr) were allocated to receive either esmolol 1 mg.kg-1 + 200 micrograms.kg-1.min-1 (the esmolol group) or saline (the control group). Heart rate and arterial pressure were measured noninvasively and ECG was analyzed with the aid of a microcomputer. Comparisons between the groups were performed using two-way analysis of variance with repeated measures and the Student's t-test. RESULTS: In the presence of esmolol, neither the heart rate nor the QTc interval of the ECG increased significantly when compared with the baseline values, with the exception that the QTc interval was increased after intubation. The increase in arterial pressure after insertion of the operating laryngoscope was not prevented in esmolol-treated patients. No cardiac arrhythmias occurred in either of the groups. CONCLUSIONS: On the basis of the present study, esmolol-bolus + infusion during alfentanil-isoflurane anaesthesia in healthy, middle-aged patients is a useful treatment in circumstances where an increase of the heart rate, prolongation of the QTc interval and cardiac arrhythmias should be avoided.

Adrenergic beta-Antagonists↗

PubMed1995

Modification of the haemodynamic responses to induction of anaesthesia and tracheal intubation with alfentanil, esmolol and their combination.

The purpose of this double-blind randomized work was to study the effect of alfentanil and esmolol and their half-dose combination on the increases of heart rate and arterial pressure and on the prolongation of the QTc interval of the ECG occurring during anaesthetic induction. Sixty ASA class I-II patient with mean age ranging from 26 to 32 yr among the groups. Patients were allocated to one of four equal groups to receive saline, esmolol 2 mg.kg-1, alfentanil 0.03 mg.kg-1 and alfentanil 0.015 mg.kg-1+esmolol 1 mg.kg-1. Anaesthesia was induced with thiopentone. Succinylcholine was used to facilitate tracheal intubation. Haemodynamic variables were measured non-invasively and the QTc interval with the aid of a microcomputer. Comparisons between the groups were performed using two-way analysis of variance with repeated measures. Both alfentanil and alfentanil-esmolol prevented the increase of heart rate and arterial pressure caused by intubation whereas esmolol prevented only the increase of the heart rate. None of the treatments prevented prolongation of the QTc interval after intubation and only alfentanil prevented that after succinylcholine. The present results suggest that in the prevention of the haemodynamic responses to tracheal intubation, the half-dose combination of alfentanil and esmolol is as effective as alfentanil and superior to esmolol. The combination is preferable to relatively large doses of either drug in circumstances where side effects, such as respiratory depression due to alfentanil or bradycardia due to both drugs should be minimized.

Adrenergic beta-Antagonists↗

PubMed1995

Effect of transdermal hyoscine on nausea and vomiting after surgical correction of prominent ears under general anaesthesia.

In a double-blind, randomized study, we have compared the efficacy of transdermal hyoscine with placebo in the reduction of nausea and vomiting in 50 patients, ASA I-II, after surgical correction of prominent ears under general anaesthesia. In the placebo group, 28%, 4% and 48% of patients suffered nausea, retching and vomiting, respectively, during the first 24 h after anaesthesia. The corresponding values in the hyoscine group were 12%, 0% and 16% (P < 0.01). In the placebo group more patients (48%) needed droperidol as an antiemetic compared with the hyoscine group (16%; P < 0.05). There was significantly more sedation in the hyoscine group.

Administration, Cutaneous↗

PubMed1995

QT interval of the ECG, heart rate and arterial pressure during anaesthetic induction: comparative effects of alfentanil and esmolol.

In a double-blind study the effect of esmolol and alfentanil on the QT interval of the ECG corrected by the heart rate (QTc), heart rate and arterial pressure during anaesthetic induction was studied in 59 oxycodone- and atropine-premedicated ASA class I-(II) patients with a mean age of 26 yr (range 15-50 yr). The patients were randomly allocated to one of the four groups: saline, esmolol 2 mg.kg-1, esmolol 3 mg.kg-1 or alfentanil 0.03 mg.kg-1. Both doses of esmolol prevented the prolongation of the QTc interval after thiopental and suxamethonium, but not after laryngoscopy and intubation. Alfentanil prevented the prolongation of the QTc interval following thiopental, suxamethonium and laryngoscopy but not after intubation. Esmolol did not prevent the increase in the heart rate and arterial pressure in response to laryngoscopy and intubation. No cardiovascular responses to laryngoscopy and intubation occurred in the patients treated with alfentanil. No cardiac arrhythmias occurred in the esmolol 3 mg.kg-1 group, whereas the frequency of ventricular ectopic beats was 40% in the saline group and 13-20% in the other groups.

Adolescent↗

PubMed1994

Prevention of nausea and vomiting with transdermal hyoscine in adults after middle ear surgery during general anaesthesia.

In a double-blind, randomized study, we have compared the efficacy of transdermal hyoscine in the prevention of nausea and vomiting with placebo in 60 young, ASA I-II patients after middle ear surgery during general anaesthesia. In the placebo group, 27% and 43% of patients suffered from nausea and vomiting, respectively, during the first 24 h after anaesthesia. The corresponding values for both symptoms in the hyoscine group were 10% (P < 0.001 between groups). The frequency of side effects was similar in both groups. The results suggest that transdermal hyoscine is a useful prophylaxis against nausea and vomiting after middle ear surgery.

Administration, Cutaneous↗

PubMed1993

A potentially hazardous interaction between erythromycin and midazolam.

Interaction between erythromycin and midazolam was investigated in two double-blind, randomized, crossover studies. In the first study, 12 healthy volunteers were given 500 mg erythromycin three times a day or placebo for 1 week. On the sixth day, the subjects ingested 15 mg midazolam. In the second study, midazolam (0.05 mg/kg) was given intravenously to six of the same subjects, after similar pretreatments. Plasma samples were collected, and psychomotor performance was measured. Erythromycin increased the area under the midazolam concentration-time curve after oral intake more than four times (p < 0.001) and reduced clearance of intravenously administered midazolam by 54% (p < 0.05). In psychomotor tests (e.g., saccadic eye movements), the interaction between erythromycin and orally administered midazolam was statistically significant (p < 0.05) from 15 minutes to 6 hours. Metabolism of both erythromycin and midazolam by the same cytochrome P450IIIA isozyme may explain the observed pharmacokinetic interaction. Prescription of midazolam for patients receiving erythromycin should be avoided or the dose of midazolam should be reduced by 50% to 75%.

Administration, Oral↗

PubMed1993

QT interval, heart rate and arterial pressures using propofol, thiopentone or methohexitone for induction of anaesthesia in children.

The effects on corrected QT interval (QTc), heart rate and arterial pressure were studied after induction with propofol 1.5, 2 or 2.5 mg.kg-1, thiopentone 5 mg.kg-1 or methohexitone 2 mg.kg-1 in 123 ASA class I or II children undergoing outpatient otolaryngological surgery. Premedication consisted of oral midazolam and atropine. The children were randomly allocated to one of the three propofol groups or to the thiopentone or methohexitone group. After injection of the intravenous anaesthetic, the QTc interval was significantly prolonged after propofol 2.5 mg.kg-1. Thirty seconds after suxamethonium 1.5 mg.kg-1, a significant prolongation of the QTc interval occurred in the thiopentone and propofol 1.5 and 2 mg.kg-1 groups. After intubation, no further prolongation of the QTc interval occurred in any of the groups. Heart rate increased significantly after the barbiturates but not after propofol. Systolic arterial pressure decreased significantly after propofol 1.5 and 2.5 mg.kg-1. In all groups a cardiovascular intubation response occurred. Bradycardia and junctional rhythm occurred in 4% of the children in both barbiturate groups and in 19-29% in the propofol groups. It is concluded that propofol causes prolongation of the QT interval and results in a higher incidence of bradycardia and junctional rhythm than the barbiturates.

Anesthesia, Intravenous↗

PubMed1993

Evaluation of postural stability by computerised posturography following outpatient paediatric anaesthesia. Comparison of propofol/alfentanil/N2O anaesthesia with thiopentone/halothane/N2O anaesthesia.

Simple clinical tests, like Romberg's test or a walking test, have proved to be inadequate guidelines for safe discharge after outpatient anaesthesia. A randomised study was therefore planned to compare postural stability measured by computerised posturography in 31 oral midazolam-atropine premedicated children aged 6.9 (s.e. 0.4) years who had been anaesthetised with either propofol/alfentanil/N2O or thiopentone/halothane/N2O. The sway velocity of the children was measured before premedication and 1, 2 and 3 h after the end of anaesthesia. Results show that sway velocity had returned to baseline values 3 h after the end of anaesthesia in all children who had received propofol/alfentanil/N2O and in 12 of the 15 children who had received thiopentone/halothane/N2O. The quantified version of the Romberg test performed with eyes open or closed was not impaired after anaesthesia, compared with the control values, indicating that in children poor equilibrium is not compensated by vision. The clinical recovery with respect to the times to eye opening, to responding to command or to being fully awake did not differ between the two anaesthesia methods. On the basis of recovery assessed by postural stability, propofol/alfentanil/N2O anaesthesia was not preferable to thiopentone/halothane/N2O anaesthesia after minor paediatric otolaryngological surgery.

Alfentanil↗

PubMed1993

Tracheal intubation after induction of anaesthesia with propofol, alfentanil and lidocaine without neuromuscular blocking drugs in children.

In a double-blind study, intubating conditions and haemodynamic responses were assessed in two age-groups of 45 ASA I-II children, with mean ages of 2.4 and 6.3 years, premedicated with oral midazolam and atropine. The children were randomly allocated to one of three groups: alfentanil 20 micrograms.kg-1 + lidocaine 1 mg.kg-1 (Alf20 + Lign); alfentanil 20 micrograms.kg-1 (Alf20); or alfentanil 40 micrograms.kg-1 (Alf40), followed by propofol 3.5 mg.kg-1 in the children aged 1-3 years and 3.0 mg.kg-1 in the older children. Intubating conditions, 40 s after the administration of propofol, were assessed as good, moderate or impossible on the basis of jaw relaxation, ease of insertion of the endotracheal tube and coughing during intubation. In the younger age group the frequencies of good, moderate or impossible intubating conditions were 87, 13 and 0% in the Alf40, 40, 60 and 0% in the Alf20 (P < 0.05 compared to the Alf40 group) and 53, 47 and 0% in the Alf20 + Lign group. In the older age group the corresponding frequencies were 60, 33 and 7% in the Alf20 + Lign, 47, 53 and 0% in the Alf20 and 47, 40 and 13% in the Alf40 group. All the drugs prevented any increase in arterial pressure and heart rate after tracheal intubation. The QTc interval of the ECG was always in the normal range. Clinically important bradycardia did not occur. In conclusion, the best intubating conditions occurred after propofol 3.5 mg.kg-1 and alfentanil 40 micrograms.kg-1 in the younger age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1992

Injection pain, cardiovascular changes and recovery following induction of anaesthesia with propofol in combination with alfentanil or lignocaine in children.

The effect of pretreatment with alfentanil 10 (Alf10), 15 (Alf15) or 20 (Alf20) micrograms.kg-1 on reducing injection pain caused by propofol was compared with lignocaine 10 mg mixed with propofol (Lign). This double-blind, double-dummy and randomized study included 100 children with a mean age of 4.3 +/- 0.6 years, 25 children in each group, undergoing minor otolaryngological surgery. The children were premedicated orally with midazolam 0.5 mg.kg-1 and atropine 0.03 mg.kg-1. Injection pain occurred in 4% in the Lign group. The corresponding figures were 40, 16 and 20% in the Alf10, Alf15 and Alf20 groups, respectively. Both 1% lignocaine 10 mg and alfentanil 15 micrograms.kg-1 reduced injection pain significantly compared with alfentanil 10 micrograms.kg-1. Pretreatment with alfentanil significantly diminished haemodynamic responses to tracheal intubation. Furthermore, the concomitant use of alfentanil and propofol caused transient severe bradycardia and a significant decrease in heart rate after laryngoscopy.

Alfentanil↗

PubMed1992

[Interactions between lithium/rubidium and six muscle relaxants. A study on the rat phrenic nerve-hemidiaphragm preparation].

The cumulative concentration-response curves for alcuronium, metocurine, d-tubocurarine, suxamethonium, pancuronium and vecuronium alone or in combination with lithium or rubidium were measured using indirectly evoked twitch tension in the isolated rat phrenic nerve-hemidiaphragm preparation. In the experiments with lithium and rubidium, 10% and 2% of the sodium ions (118 mmol/l) of Krebs solution were replaced by lithium (11.8 mmol/l = 0.082 g/l) or rubidium (2.36 mmol/l = 0.202 g/l) ions, respectively. At these concentrations, neither lithium nor rubidium alone affected twitch tension. Lithium led to a statistically significant enhancement of the myoneural blocking effects of suxamethonium, pancuronium and vecuronium, but not of the other myoneural blocking drugs. Rubidium behaved similarly to lithium, except that enhancement of the effect of vecuronium was not statistically significant. At higher concentrations, lithium and rubidium alone depressed twitch tension in a dose-dependent manner. Neither myoneural blocking drugs nor lithium and rubidium affected the directly evoked twitch tension. It is concluded that myoneural blocking drugs, especially the newer ones, should be used with caution in patients receiving lithium or other alkali metal therapy as it is not known what interactions may arise.

Animals↗