European journal of anaesthesiology
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The brachial plexus was identified by electrical stimulation before interscalene block with 30 mL 0.5% bupivacaine and adrenaline 1:200,000. During injection, compression was applied with a finger proximal to the injection site. Spirometric measurements were made before the block, and then at 5 min, 10 min, 20 min and 4 h after the injection. ⋯ Twenty minutes after the injection, the forced vital capacity was 27% less, forced expiratory volume at 1 s 34% less and peak expiratory flow rate 15% less (all P < 0.05). Right diaphragmatic excursion decreased from 4.5 cm (SD 1.2 cm) to 1.8 cm (0.6 cm) at 15 mins and to 1.1 cm (0.6 cm) at 4 h (P < 0.05). Identification of the plexus by electric stimulation combined with finger compression above the injection site did not prevent diaphragmatic paresis.
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We report a case of post-operative rhabdomyolysis following transmandibular buccopharyngectomy without reconstruction in a patient remaining in the supine position throughout the procedure. Muscle compression induced by a cushion used during the procedure had probably contributed to the rhabdomyolysis. Outcome was favourable without acute renal failure. Prevention, early diagnosis and treatment are the keys to a successful recovery.
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Ringer's solution expands blood volume by between 20% and 25% in awake volunteers, but little is known about its volume effect during general anaesthesia. In 35 men with a mean age of 70 years, the power of various intra-operative factors to change blood volume as estimated by the haemoglobin dilution method were analysed by multiple linear regression every 10 min during transurethral resection of the prostate performed under enflurane anaesthesia. ⋯ There was no correlation between systolic pressure and blood volume changes. This suggests that the volume effect of Ringer's solution in the blood is greater than generally believed during general anaesthesia.
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The use of suppositories has been examined following a recent case in which an anaesthetist was reported to the United Kingdom General Medical Council. This study examined the preference for routes of administration of post-operative analgesia. ⋯ The i.v. route was most popular with young (98% under 20 years) females (79%) social class I subjects (90%), doctors (96%), nurses (95%), those who had never had a suppository (81%) and those who had ill effects following a previous suppository (95%). This result suggests that patients are more tolerant of suppositories than hospital staff but the majority prefer the i.v. route.
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Ten patients, predicted to pose a difficult intubation of the trachea, underwent inhalational induction of anaesthesia using sevoflurane. In all 10 cases the airway was secured successfully and the patient proceeded to have the planned operation. In six of the cases the anaesthetist experienced a problem during the induction but in no case did this present any real difficulties or lead to a critical incident. We feel that sevoflurane has a place for inhalational induction in this challenging group of patients.