Propofol VS Thiopental Essay Research Paper AbstractNeuromuscular

Propofol V/S Thiopental Essay, Research Paper

Abstract

Neuromuscular blocking agents are an essential aspect of attaining adequate muscle relaxation in patients prior to attempting endotracheal intubation. Succinylcholine is one these agents used, most commonly when attempting a rapid sequence induction. Succinylcholine administration is associated with muscle fasciculations and subsequent myalgias postoperatively. A nondepolarizing neuromuscular agent is commonly administered to reduce the occurance of fasciculations and myalgias. Additionally, the induction agent Propofol, has been associated with further reducing fasciculations and myalgias. Propofol and Pentothol are commonly used anesthetic agents and are generally interchangable and equally efficacous.

Studies have elluded to the ability of Propofol to reduce theses occurances, but it has not been demonstrated in all areas. This study hypothesis that when a standard dose of nondepolarizing agent is given in conjuction with Propofol the occurances of fasciculations and myalgias will be reduced more effectively than with Pentothol.

An all male population has been selected to reduce confounding results that may be attained when female subjects are studied, as females are generally accepted to have greater levels of postoperative myalgia. Routine induction will proceed with the patient receiving standard doses of Fentanyl, Versed and a defasciculating dose of Rocuronium, calculated at 10% of the induction dose. Group A will receive 1.5 mg/kg to 2 mg/kg of Propofol and Group B will receive 3 mg/kg to 5 mg/kg of Pentothol. Patients will be graded on occurances of fasciculations on a scale of 0 (none) to 3 (severe). Patients will be contacted at 24 hours postop to ascertain a self report of perceived muscle myalgia, and will be reported on a scale of 0 (none) to 10 (severe).

The results of this study will be expected to demonstrate that the administration of Propofol will significantly reduce the incidence of fasciculations and myalgia over the adminstration of Pentothol.

Conculusions should demonstrate that administrating Propofol when attempting a rapid sequence induction with Succinylcholine will decrease patients fasciculations and perception of postoperative myalgias.

Introduction

Neuromuscular blocking agents are an essential aspect of attaining muscle relaxation in patients prior to attempting endotracheal intubation. They provide vocal cord paralysis which facilitates ease in intubating the trachea. A multitude of agents are available to assist in this procedure. Neuromuscular blocking agents are used for intubation based on the patients needs for length and onset of paralysis.

Commonly, patients present with various pathologies that demand the trachea be intubated with a Rapid Sequence Induction. The administration of Succinylcholine is considered the gold standard in the Rapid Sequence Induction. It attains proper muscle relaxation for intubating rapidly, and its short length of duration and allows the patient to spontaneously breath again, in minutes, if intubation was unsuccessful.

Succinylcholine in induction doses is responsible for patients experiencing muscle fasciculation’s. Fasciculation is the involuntary contraction or twitching of muscle fibers, frequently visible under the skin. They are the result of antidromically conducted axonal depolarization’s initiated by Succinylcholine binding on prejunctional nicotinic cholinergic receptors (Harvey, etal.., 1998). The reduction of fasciculation’s attributed to the pretreatment of non-depolarizing muscle relaxants are the result of competitive antagonism for postjunctional nicotinic cholinergic receptors. Fasciculation’s are not always visually noticeable, but their occurrence, visible or not, are highly attributable to patients suffering from postoperative myalgia.

Myalgia is characterized by general muscular discomfort or malaise that may also be acutely painful. Myalgia is due to the same physiological mechanisms that are attributed to muscular fasciculations. It is common place to “pretreat” patients with a non-depolarizing neuromuscular paralytic to reduce the occurrence of fasciculations with hopes that a subsequent reduction of postoperative myalgias will be reduced as well.

Significance to Nursing

The act of administering a pretreatment is termed a defasciculating dose. However, quite often the pretreatment is insufficient in effectively reducing the occurrence of fasciculation’s and myalgias. The administration of succinylcholine is credited with an incidence of myalgias near 75% without any pretreatments. The administration of rocuronium is credited with reducing the incidence by 60%. However, the administration of any non-depolarizing muscle relaxants to reduce postoperative myalgia remains controversial.

Postoperative myalgias are discomforting to the patient and often hinder the patients efforts to increase mobility, contribute to general malaise, and can result in increased pain relief needs. Nurse Anesthetists are often responsible to providing as much as 100% of the anesthetic medications depending on practice guidelines that vary from one institution to the next. Reducing postoperative pain through proactive measures is an outcome that is taken into the anesthetic plan. Therefore, measures that may be undertaken to reduce Succinylcholine induced fasciculation and subsequent myalgias are warranted.

Specific Aims

Several articles reviewed report various and often contradictory results regarding the most effacious method of pretreatment in preventing myalgia’s. It is commonly recommended that when pretreating patients with non-depolarizing muscle relaxants, 10% of the intubating dose offers some protective benefits without compromising the patients efforts to breathe spontaneously. Rocuronium is stated to be best defasiculating drug when administration of succinylcholine is within 1-4 minutes. Curare is stated best in reducing myalgias if a full 5 minutes are allowed between its administration and the administration of succinylcholine. However allowing for a full 5 minutes for the therapeutic effects of curare is not always plausible in the dynamic setting of the operating room. It is for reasons of time management that rocuronium is selected for this study.

Propofol has been credited with further reducing postoperative myalgias when used as the induction agent as opposed to pentothal It has been theorized that succinylcholine induced myalgias are partly attributable to the production of free radicals. Propofol has antioxidant properties and may for these reasons have advantages over other induction agents, i.e.. Pentothal Propofol and Pentothal are the most commonly used agents for induction. The goal of this study is to determine if a combination of rocuronium and Propofol is more efficaous than the combination of Rocuronium and Pentothol at reducing the incidence of postopertive myalgias

Review of Literature

This chapter presents a review of the literature pertaining to the practice of reducing succinylcholine induced postoperative myalgias, the technique of defasciculating dose and the efficacy of various drug agents employed. The literature on defasciculating doses focused on ascertaining which drug is most conducive in the operating room setting and also is most efficacious in reducing the occurrence fasciculation’s and myalgias. The review also considers which hypnotic drug used for anesthetic induction’s further reduce the incidence of postoperative myalgias. The information reviewed concerning hypnotic induction drugs focused on Propofol and pentothol. Pretreatment: (defasciculation dose) The intravenous administration of a dose that is 10% of the intubating dose of a nondepolarizing muscle relaxant prior to administering Succinylcholine. This paper uses specific technical terms that are defined as follows:

Induction is the administration of barbiturates, benzodiazepines, opioids, or other hypnotic medication in combination to produce surgical anesthesia. Usually followed by the administration of a muscle relaxant. A bolus is the single intravenous administration of a substantial volume of a dose of medication, in this study, Propofol, thiopental, and succinylcholine.

Framework

Fasciculations are the result of antidromically conducted axonal depolarization’s initiated by Succinylcholine binding on prejunctional nicotinic cholinergic receptors (Harvey, etal.., 1998). The reduction of fasciculation’s attributed to the pretreatment of non-depolarizing muscle relaxants are the result of competitive antagonism for postjunctional nicotinic cholinergic receptors.

The theory behind the defasciculation dose is that a small dose of a neuromuscular paralytic will partially occupy the post-junctional receptor in the neuromuscular junction, reducing the available receptor sites in the neuromuscular junction and diminishing the intensity of succinylcholine induced fasciculations.

Defasciculating drugs

Harvey, Roland, Bailey, Tomlin and Williams (1998) conducted a study comparing d-Tubocurarine, Rocuronium and “mini dose” Succinylcholine in reducing Succinylcholine-induced fasciculation’s and myalgias. One hundred one patients were included in a randomized single blinded study randomized into 5 study groups. Groups were randomized according to the pretreatment given prior to receiving 1.5 mg/kg of succinylcholine. Group one was the control group, receiving normal saline, group two received 0.03 mg/kg of rocuronium, group three received 0.05 mg/kg of Rocuronium, group four received 0.05 mg/kg and group five received 0.03 mg/kg of succinylcholine. Pentothal 4-5 mg/kg was administered 3.5 minutes after the pretreatment and 1.5 mg/kg of Succinylcholine was subsequently administered after establishing an airway following pentothal induction. Fasciculations were graded from none or from 0-2, being mild moderate and severe, respectively. All participants were contacted on the day following surgery and myalgias were rated on a similar scale ranging from none to severe.

The results showed that fasciculations were absent in 5% or group one, 90% in group 2, 75% in group 3, 80% in group 4 and 30% of group 5. There was no difference in the severity of fasciculations of between the groups administered Rocuronium or d-Tubocurare. The difference in fasciculations between the control group and the “mini dose” Succinylcholine groups were similar. The occurrence of postoperative myalgias was 11.5% and was not significantly different across the groups. The results support that Rocuronium is as efficacious as d-Tubocurare in reducing fasciculation’s at equipotent doses, with on difference in the occurrence of myalgias.

Tsui, Reid, Gupta, Kearney, Mayson and Finucane conducted a study to determine if Rocuronium was superior to Atracurium in reducing fasciculations and postoperative myalgias. They conducted a prospective double-blind randomized study with 42 patients assigned to 3 pretreatment groups. Group one received normal saline, group two received 0.1 mg/kg of Atracurium and group three was pretreated with 0.1 mg/kg of Rocuronium. Standardized induction for all groups commenced with 1.5 mic/kg of fentanyl and 0.5 mg/kg of lidocaine, pretreatment was administered immediately after, followed 60 seconds later with 2.5 mg/kg of Propofol and 1.5 mg/kg of Succinylcholine at 90 seconds after pretreatment.

Fasciculations and myalgias were rated on four point scales by ranking them from none to severe. The incidence of fasciculations among the participants pretreated with Rocuronium was 21.4%, lower than Atracurium by 57.1%. The occurrence of fasciculation’s in the control group was 92.8%. The incidence of postoperative myalgias was 14.2% in the Rocuronium group, 85.7% in the atracurium group and 78,2% in the control group. The researchers used fishers exact test to conclude that rocuronium with Propofol reduced significantly the occurrence of fasciculations and myalgias.

Demers, Pelletier, Drolet, Girard and Donati (1997) conducted a study comparing d-Tubocurare and Rocuronium for preventing Succinylcholine induced fasciculations and postoperative myalgia. Seventy five women wee included into the study whom presented for short surgery. They were randomized in a double-blind fashion and placed into one of three study groups. Group SAL received normal saline, group ROC received 0.05 mg/kg of Rocuronium and group DTC received 0.05 mg/kg of D-tubocurare, all followed by the administration of 1.5 mg/kg of Succinylcholine. Fasciculation’s were assessed as nil, fine, moderate, and severe and rated by a blinded observer on a scale of 0-3, respectively. Patients were contacted at 24 and 48 hours postop and were asked to rate their myalgia on a scale of 0-10. Fasciculations were rated as more intense in the SAL group than in the ROC or the DTC groups with no significant difference between ROC or DTC groups. Patients rated postoperative myalgias as less intense only in the ROC group. They concluded that Rocuronium reduces fasciculation’s as well as d-tubocurare and is the more efficacious in reducing postoperative myalgia.

Hypnotic drugs

McClymont (1994) investigated the incidence of postoperative myalgia in a comparison study between Propofol and Pentothal prior to the administration of succinylcholine. A total of 51 patients, presenting for laparoscopic gynecological surgery, were enrolled in this prospective, blinded, experimental study. The subjects were assigned into 2 study groups, group A received Propofol and group B received pentothal as their induction agent prior to the administration of succinylcholine. Both groups were given 1mg/kg of succinylcholine to facilitate the insertion of an endotracheal tube. A questionnaire was sent home with the participants to complete and return. Subjects were instructed on how to properly complete questionnaire as it contained a pain linear analogue scale. The results were analyzed with Student’s t-test and the nonparametric data were analyzed with a fisher’s exact test. The results concluded that Propofol effectively reduces the incidence of succinylcholine induced myalgias, when compared to pentothal The pentothal group experienced myalgias at a 63% incidence as opposed to 19% in the Propofol group.

A study conducted by Maddineni, Mirakhur and Cooper (1992) sought to correlate the incidence of postoperative myalgias and changes in creatine kinase following 1mg/kg of succinylcholine immediately or two minutes after anesthetic induction with Propofol, 2-3mg/kg, or pentothal 3-5mg/kg, in patients having dental or ophthalmic surgery. In 1992, Propofol was recently introduced and the researchers recognized a gap in knowledge concerning potential benefits or adversities when given prior to succinylcholine. The study was designed to assess the incidence of fasciculatio’s, myalgias and muscle damage, measured by creatine kinase levels. Eighty patients between ages, 16 and 65 were enrolled into the study, 40 patients into each Propofol and pentothal groups. Twenty patients in each group were further randomized into groups receiving succinylcholine immediately after and two minutes after the induction agents Propofol or pentothal Fasciculations were observed in nearly 90% of the participants, however, myalgias were reported at 46% incidence. The occurrence appeared to reduced when succinylcholine was administered immediately after the induction agent, however, no significant difference was noted. The researchers reported that their findings of the incidence of myalgias were comparable to previously studied control groups receiving no treatment. Propofol was not concluded to have any greater beneficial effects on postoperative succinylcholine induced myalgias.

Smith, Ding and White (1993) conducted a single-blind, randomized study to compare various pharmacological techniques in relation to succinylcholine induced myalgias. The study included 155 women undergoing laproscopic surgery and assigned to one of five study groups. Group one received pentothal, 4mg/kg, and succinylcholine, 1mg/kg, followed by enflurane and nitrous oxide inhalation agents. Group 2 only varied by receiving d-Tubocurare, 3mg, and succinylcholine 1.5mg/kg. Groups 3 and 4 only varied by receiving Propofol, 2mg/kg, instead of pentothal, and group 4 received a continuous infusion of Propofol. Group 5 received atracurium instead of succinylcholine. All groups were treated similar in the postoperative phase.

The incidence of myalgias were reduced in group two, and fasciculations were not observed when succinylcholine was not administered. Myalgias were measured by the presence of shoulder and/or neck pain. Shoulder pain was present in 81% of all patients, with no significant difference among the groups. Neck pain occurred less often in all groups and the incidence was even less in group 5. Propofol had no significant effect in reducing postoperative myalgias. The study concluded that laproscopic surgery has a high incidence of shoulder pain and was present in the absence of succinylcholine. The only significant finding was that the avoidance of succinylcholine resulted in less neck pain.

Gap

In summary, the research presented in this literature review will be utilized as the basis for design of this research proposal. The pretreatment or defasciculation doses of nondepolarizing neuromuscular muscle relaxants have been shown to significantly reduce the incidence of myalgias and fasciculation’s when administered from 90 seconds to 4 minutes prior to succinylcholine. The recommended dose of 10% of the intubating dose of Rocuronium, d-tubocurare, succinylcholine and atracurium have all shown to reduce these incidences. Rocuronium has been shown as efficacious in reducing the incidence of fasciculation’s and myalgias as d-tubocurare, and allows for the administration of succinylcholine in 90 seconds as opposed to 3-5 minutes for d-tubocurare. These results serve as the basis for selecting Rocuronium as the defasciculation agent.

The occurrence of myalgia’s vary within different groups of patients and it has generally understood that it occurs more frequently in women, for reasons yet not fully understood. Propofol has been shown in some studies to reduce the incidence of muscle fasciculations and postoperative myalgias, to a greater degree than with pretreatment alone. However, Smith et al.. (1993) concluded that Propofol did not significantly reduce the incidence of postoperative myalgia, however, the selection of an all female group may be a confounding factor in the results. The results of the studies in women effectively demonstrate a decreased occurrence of myalgias with the use of Propofol prior to succinylcholine. It could perhaps be concluded that the incidence would be further reduced in men and is the basis for selecting an all male group and controlling for this potential confounding factor.

Method

Research Question

This study seeks to determine the incidence and severity of fasciculations and myalgias associated with the administration of Succinylcholine. Is there an association between incidence and severity of fasciculation’s and myalgias and does the administration of Propofol or Pentothol reduce the occurance after rapid sequence inductions?

Design

This study design will be quasi-experimental in nature and will be a prospective, randomized, single-blinded design.

Population & Sample

The convenience sample will be obtained by reviewing the surgical schedule for the next day and selecting candidates that prospectively meet the criteria for inclusion. The study is open only to males with no restriction on ethnicity. ASA is the American Society of Anesthesiology risk categories that rates patients as healthy, ASA 1, to moribund, ASA 5. Inclusion criteria includes: Age 35 years and older, preoperative ASA classification of 1 through 3, Surgical procedure which requires general surgery with rapid sequence induction.

Exclusion criteria include: known hypersensitivity to Pentathol, Propofol or Succinylcholine; personal or familial history of malignant hyperthermia; patients undergoing emergency surgery, surgery of the neck and shoulder area, or laproscopic surgery of the abdomen; body weight deviations greater than 25% from ideal; known neuromuscular disorder; preexisting neck or shoulder discomfort: failure, inability or unwillingness to give informed consent. Patients that are unable to receive either Pentothol or Propofol in each case will not be included in the study.

Setting

The experimental study will be conducted at the Minneapolis Veterans Administration Medical Center. The treatment will be administered in the operating room. The subjects will be monitored using routine methods for ECG, blood pressure, oxygen saturation, temperature, muscle paralysis and end tidal carbon dioxide.

Measurements

Fasciculations

Fasciculations are the involuntary muscle activity observed after the administration of Succinylcholine. The rating of Muscle fasciculatio’s tool used will be a standardized numeric scale ranging from 0 through 3. Fasciculation’s will be observed by the anesthesia personnel administering the anesthetic. Criteria used to describe fasciculation’s will be described as: nil (0); fine tremors of the face and neck (1); moderate fasciculation’s affecting the neck and limbs (2); severe vigorous, widespread fasciculation’s (3). These conditions are ranked according to criteria similar to that used by Demers-Pelletier, etal.. (1997). No validity are given by raters for this measurement. However, a high level of rater reliability will be attained since the primary investigator will be present to observe each case.

The occurance of fasciculation’s will be monitored by the investigator by assessing for muscle tremors and contractions immediately following the administration of Succinylcholine until three minutes post administration. Succinylcholine is known to have a rapid onset, generally occurring at the 60 to 90 second mark. The observations will be rated and recorded on the standardized assessment tool.

Myalgia

Myalgia is the presence of muscle discomfort. May range from slight aching to pain that limits activities. In this study, the pain experienced purportedly caused by the administration of Succinylcholine. The rating of postoperative myalgia will be a subjective measure reported by the patient instructed in the scale measurement. The rating will be a standardized numeric scale ranging from 0 through 10. Patients will be contacted at 24 hours postoperatively and asked to rate their myalgia. Patients reporting no myalgia will rate a 0, increasing in intensity to 10. The neck and shoulders commonly exhibit symptoms of Succinylcholine induced muscle myalgia, and will be the area assessed for myalgia. Rater reliability will be attained since the primary investigator will contact and record the results in each case.

Design

Subjects will be randomized into two treatment groups using the last digit of their social security number (SSN). Subjects will be assigned to Group A if their SSN ends with zero through four. Subjects will be assigned to Group B is their SSN ends with five through nine. Both groups will receive a defaciculating dose of Rocuronium, being 10% of the induction dose, followed three minutes later by induction. Group A will begin induction by receiving 1.5 mg/kg to 2 mg/kg of Propofol, followed within 3 minutes by the administration of 1.5 mg/kg of Succinylcholine. Group B will begin induction by receiving 3 mg/kg to 5 mg/kg of Pentathol, followed within 3 minutes by receiving 1.5 mg/kg to 2 mg/kg of Succinylcholine.

The CRNA performing the anesthetic will conduct drug preparation after determining the group to which a given subject was assigned.

Proceedure

Subjects will be greeted in the operating room holding area. The investigator and the case CRNA will conduct the standard anesthetic preoperative interview. Criteria for exclusion will be addressed with the case CRNA, and the case anesthesiologist at that time. Patients will be informed of the study and consent will be attained if subjects agree to participate. An intravenous catheter will be placed in either arm.

Once consent has been attained, the subjects will be transported to the operating room. The standard monitoring devices will be placed on the subject. All subjects will routinely be medicated with 2mg of Midazolam and 3-5 CC of Fentanyl for sedation and amnesia prior to the administration of the defasciculating dose of Rocuronium. The usual induction will begin with preoxygenation, consisting of placing mask over the mouth and nose and applying 8-12 L/minute flow to the patient. All medications will be administered via the intravenous line as per usual routine.

Pretreatment is the intravenous administration of 10% of the calculated intubating dose of Rocuronium three minutes prior to administering Succinylcholine. Once the investigator and case anesthesia personnel are prepared for induction, a pretreatment is calculated as 10% of the intubating dose of Rocuronium and will be administered as the defasciculation dose. Patients are monitored at this time for any changes in breathing or muscle weakness. At the three minute mark, Group A will receive a bolus dose (1.5 mg/kg to 2 mg/kg) of Propofol, and Group B will receive a bolus dose of Pentathol (3mg/kg). Induction will proceed within 3 minutes with the administration of a bolus dose of Succinylcholine (1.5 mg/kg).

The usual rationale for utilizing either Pentathol or Propofol is based on the patients ability to hemodynamically withstand the depressant effects of these two agents. The usual circumstance allows for either agent to be utilized equally. Because of the occurance of vascular pain upon the injection of Propofol, the administration of Lidocaine (.0.5mg/kg) will be injected prior to administering Propofol. Lidocaine stabilizes membranes and could potentially affect the action of Succinylcholine. The use of Lidocaine will therefore be standardized at 0.5 mg/kg. Following the induction and intubation, the patients general anesthetic will be administered in the usual routine

The patient will be contacted by the investigator at 24 hours time. The patient will be asked to rate the presence of any muscle ache (myalgia) or pain in the neck and shoulders area. The patient will be asked to rate the intensity of myalgia on a scale of 0 to 10. The rating will be recorded on the standardized scale by the investigator.

Limitations

This study will follow the designs for quantitative comparison between two groups. Limitations are that quantitative measures are assigned to qualitative observations. Numbers can be satisfactorily applied to these measures, but different individuals my interpret the qualitative experience differently and therefore assign varied quantitative measures to similar events. All variables that may confound the data must be controlled. Confounding variables may be present without awareness and are subsequently uncontrolled. Results obtained from small groups may not have the power to detect real differences in groups. Dosing calculations or timing may not be exact and vary so as to confound the results. The drug properties may vary somewhat from lot to lot and alter therapeutic effects.

There are several limitations to this design, however, if methodology is followed closely, confounding variables may be sufficiently controlled. Anesthesia personnel understand the value of research and are competent enough to make precise calculations when administering drugs and can be entrusted to correctly follow study protocol.

Protection of Rights of Participants

Researchers are asking patients to participate in an experimental study. The patients are asked to listen to the study requirements, benefits and risks, and at such time they are satisfied with study issues, consent to enter the study. This study does not place patients at any greater risk of adverse effects than the current risk already in existence for their operative procedure and anesthetic administration. The medications administered to either of the groups are used routinely and are accepted anesthetics. The participants are not being forced or coerced to enter the study against their will. Risks are less than the benefits and it is concluded that this study adds no risk, and has the potential for benefiting future practice. The potential benefits gained through this study is the knowledge gained in administering anesthesia in a manner that reduces postoperative myalagia caused by the administration of Succinylcholine. It is theorized that the results of this study will provide information on the more efficacious course of action to minimize fasciculation’s and myalgias.

The patients will receive full disclosure before being asked to consent, and will be treated respectfully throughout the study and all results will remain confident in order to preserve the patients anonymity. Vulnerable subjects will not be considered for entry into the study without the consent of the legal guardian. This proposal will be presented to the Institutional Review Board for approval.

Patients will be screened for absolute contradictions for the study. Patients whom have demonstrated sensitivity to any of the drugs included within the study design will not be entered. Patients who are not cardiovascularly stable, and require induction with an agent with less hypotensive properties will not be considered. No patient’s anesthetic will be modified to facilitate this study so as to place the patient at increased risk. Participants in both groups will be given a drug that is directly responsible for fasciculation’s and myalgias, and no definitive treatment is being withheld that reduces the intensity.

Data Analysis Plan

A Chi square (X2) test for independence with frequencies for myalgias and fasciculations will be utilized. The mean, median and mode will be analyzed and presented.

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References

Demers-Pelletier, J., Drolet, P., Girard, J., & Donati, F. (1997). Comparison of rocuronium and d-tubocurarine for prevention of succinylcholine-induced fasciculations and myalgia. Canadian Journal of Anaesthesia, 44, 1144-1147.

Harvey, S. C., Roland, P., Bailey, M. K., Tomlin, M. K., & Williams, A. (1998). A randomized, double-blind comparison of rocuronium, d-tubocurarine, and “mini dose” succinylcholine for preventing succinylcholine-induced muscle fasciculations. Anesthesia & Analgesia, 87, 719-722.

Maddineni, V. R., Mirakhur, R. K., & Cooper, A. R. (1993). Myalgia and biochemical changes following suxamethonium after induction of anaesthesia with thiopentone or Propofol. Anaesthesia, 48, 626-628.

McClymont, C. (1994). A comparison of the effect of Propofol or thiopentone on the incidence and severity of suxamethonium-induced myalgia. Anaesthesia & Intensive Care, 22, 147-149.

Smith, I., Ding, Y., & White, P.F. (1993). Muscle pain after outpatient laproscopy–influence of Propofol versus thiopental and enflurane. Anesthesia & Analgesia, 76, 1811-1184.

Tsui, B. C., Reid, S., Gupta, S., Kearney, R., Mayson, T., & Finucane, B. (1998). A rapid precurarization technique using rocuronium. Canadian Journal of Anasthesia, 45, 397-401.

Variable Measurement Form

Height:__________ Age:____________

Weight:_________ ASA: ___________

Treatment Group A: 1.5 mg/kg-2 mg/kg Propofol

B: 3 mg/kg-5 mg/kg Pentothol

Pt Complaints after defasciculation dose: Dyspnea Muscle weakness Other:____________

Time of Bolus after defasciculation dose ( in minutes): 1 1.5 2 2.5 3 3.5

Drugs: Fentanyl (cc)__________ Versed (mg)__________ Lidocaine (mg/kg)_________

Propofol (mg/kg)________ Rocuronium (mg/kg):_________

Rating of Fasciculations

0 1 2 3

None Mild tremors of Moderate contractions Severe, vigorous and

Face and neck of the neck and/or limbs widespread

Rating Postoperative myalgia

Hours postoperative patient contacted:_______

0 1 2 3 4 5 6 7 8 9 10

None mild moderate severe

BIOSKETCH

Supply Budget

Supplies:

- copying costs, free to student at VA Hospital clinical site

- paper, free to student at Va Hospital clinical site

- transportation costs, incurred by student

- drug cost, supplied by clinical site anesthesia dept.

Time Line

4/2000 – Proposal complete

6/2000 – Submit proposal packet to University of Minnesota advisor and VA hospital IRB

8/2000 – Conduct research

9/2000 – Compile data, analyze findings

10/2000 – Complete plan B

Bibliography

References

Demers-Pelletier, J., Drolet, P., Girard, J., & Donati, F. (1997). Comparison of rocuronium and d-tubocurarine for prevention of succinylcholine-induced fasciculations and myalgia. Canadian Journal of Anaesthesia, 44, 1144-1147.

Harvey, S. C., Roland, P., Bailey, M. K., Tomlin, M. K., & Williams, A. (1998). A randomized, double-blind comparison of rocuronium, d-tubocurarine, and “mini dose” succinylcholine for preventing succinylcholine-induced muscle fasciculations. Anesthesia & Analgesia, 87, 719-722.

Maddineni, V. R., Mirakhur, R. K., & Cooper, A. R. (1993). Myalgia and biochemical changes following suxamethonium after induction of anaesthesia with thiopentone or Propofol. Anaesthesia, 48, 626-628.

McClymont, C. (1994). A comparison of the effect of Propofol or thiopentone on the incidence and severity of suxamethonium-induced myalgia. Anaesthesia & Intensive Care, 22, 147-149.

Smith, I., Ding, Y., & White, P.F. (1993). Muscle pain after outpatient laproscopy–influence of Propofol versus thiopental and enflurane. Anesthesia & Analgesia, 76, 1811-1184.

Tsui, B. C., Reid, S., Gupta, S., Kearney, R., Mayson, T., & Finucane, B. (1998). A rapid precurarization technique using rocuronium. Canadian Journal of Anasthesia, 45, 397-401.

Variable Measurement Form

Height:__________ Age:____________

Weight:_________ ASA: ___________

Treatment Group A: 1.5 mg/kg-2 mg/kg Propofol

B: 3 mg/kg-5 mg/kg Pentothol

Pt Complaints after defasciculation dose: Dyspnea Muscle weakness Other:____________

Time of Bolus after defasciculation dose ( in minutes): 1 1.5 2 2.5 3 3.5

Drugs: Fentanyl (cc)__________ Versed (mg)__________ Lidocaine (mg/kg)_________

Propofol (mg/kg)________ Rocuronium (mg/kg):_________

Rating of Fasciculations

0 1 2 3

None Mild tremors of Moderate contractions Severe, vigorous and

Face and neck of the neck and/or limbs widespread

Rating Postoperative myalgia

Hours postoperative patient contacted:_______

0 1 2 3 4 5 6 7 8 9 10

None mild moderate severe

BIOSKETCH

Education

MS (2001) Nursing (Plan B: Nurse Anesthesia)

University of Minnesota, Minneapolis

BS 1997 Nursing

University of Arkansas for Medical Sciences, Little Rock

Professional Employment

1999 Student Registered Nurse Anesthestist, Anesthesia Dept.

Veterans Affairs Hospital, Minneapolis, MN

1997-99 Staff Nurse, Surgical Intensive Care Unit

Veterans Affairs Hospital, Little Rock, AR

1996-97 Student Nurse Technician, Surgical Intensive Care Unit

Veterans Affairs Hospital, Little Rock, AR

Certifications/Registrations

Nursing Liscense: Arkansas, 2000

Minnesota, 2001

Wisconsin, 2001

BLS, 1995 to current

ACLS, 1997 to current

Critical Care, 1997

ECG, 1997

Professional Memberships

Sigma Theta Tau, Nursing Honor Society, 1997

Supply Budget

Supplies:

- copying costs, free to student at VA Hospital clinical site

- paper, free to student at Va Hospital clinical site

- transportation costs, incurred by student

- drug cost, supplied by clinical site anesthesia dept.

Time Line

4/2000 – Proposal complete

6/2000 – Submit proposal packet to University of Minnesota advisor and VA hospital IRB

8/2000 – Conduct research

9/2000 – Compile data, analyze findings

10/2000 – Complete plan B