Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2004
Case ReportsAn unexpectedly difficult intubation following repeated endoscopy.
A 67-year-old man required an urgent laparotomy for a bleeding gastric ulcer. He had undergone three upper gastrointestinal endoscopies over five days since admission to hospital. ⋯ A fibreoptic intubation through a laryngeal mask airway was performed with difficulty. The management of this case of difficult intubation following repeated endoscopy is presented.
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Anaesth Intensive Care · Apr 2004
Muscle weakness after muscle relaxants: an audit of clinical practice.
Residual muscle weakness after general anaesthesia, assessed using handgrip strength, was audited in a teaching hospital. The relationships between residual weakness, the use of muscle relaxants and patient characteristics were examined. Handgrip strength was measured preoperatively, one hour postoperatively and one day postoperatively using a hand dynamometer in 151 patients having general anaesthesia. ⋯ The mean decline in handgrip strength in the male patients who received either vecuronium or rocuronium was similar to that seen when relaxants had not been used (P=0.40). One hour postoperatively, female patients showed a marked decrease in handgrip strength after both vecuronium and rocuronium (32% and 34% respectively, combined P=0.01). These results suggest that in usual clinical practice at our institution, female patients are more likely to have residual weakness after muscle relaxants.
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Anaesth Intensive Care · Apr 2004
Anaesthesia for electroconvulsive therapy: a comparison of sevoflurane with propofol.
This study was a prospective audit of patients receiving either intravenous induction of anaesthesia with propofol 2 mg/kg or inhalational induction using 8% sevoflurane for patients undergoing electroconvulsive therapy (ECT). All patients received inhaled 50% nitrous oxide. The anaesthetic agent was determined by psychiatrist preference. ⋯ Discharge times were similar Minor adverse effects occurred in three patients, all in the sevoflurane group (one bradycardia and two episodes of post-procedural nausea). There were no major adverse events in either group. Propofol and sevoflurane both appear to be suitable agents for induction of anaesthesia for ECT.
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We describe a case of knotting of a femoral nerve catheter which prevented removal by traction after knee replacement surgery. In this context, early surgical removal should be performed as bacterial colonization of femoral catheters is common. Radiological imaging of the catheter may assist decision-making about whether to persist with traction and what surgical approach is required. Minimizing the length of catheter inserted to less than 10 cm makes knotting unlikely, but will decrease the chance of achieving lumbar plexus blockade which could improve analgesia if the catheter passes centrally.