Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 1993
Vecuronium-thiopentone induction for emergency caesarean section under general anaesthesia.
Induction of general anaesthesia for emergency caesarean section has always been hazardous. Acid aspiration syndrome and adverse reactions to suxamethonium are well recognised problems, in spite of which "crash" induction using thiopentone and suxamethonium remains a common induction technique. Recent case reports suggest that the use of medium duration nondepolarising relaxants in place of suxamethonium achieves satisfactory intubating conditions in the emergency caesarean section patient. ⋯ To detect instances of acid regurgitation or aspiration. 5. To confirm that relaxant reversal is clinically effective at the completion of surgery. In this series of thirty cases, vecuronium 8 mg preceding thiopentone 250 mg and atropine 0.6 mg by 20 seconds provided effective induction and easy intubating conditions without clinical effects on the newborn, maternal acid aspiration, or clinical signs of persistent paralysis after reversal.
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Accidental dural puncture is a well-recognised complication of epidural anaesthesia. The technique of inserting the epidural needle with the bevel parallel to the spinal ligaments is still taught in some centres. ⋯ There would also appear to be a greater chance of subdural catheterisation. The epidural needle should be introduced with the bevel in the direction in which the catheter is to go and not moved once the epidural space is located.
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Anaesth Intensive Care · Jun 1993
The influence of obesity on the relationship between body mass index and the distance to the epidural space from the skin.
This study confirms that distance to the epidural space from the skin at the L3-4 interspace is only moderately correlated with body mass index in obstetric patients. A similar moderate linear correlation was found in the non-obstetric patients. However, in obese patients (BMI > 25), distance to epidural space from the skin correlated poorly with body mass index.
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Anaesth Intensive Care · Jun 1993
Biography Historical ArticleClover's nitrous oxide/ether inhaler 1876.