Anaesthesia and intensive care
-
Anaesth Intensive Care · Nov 1990
Does suxamethonium influence the subsequent dose requirements of alcuronium and its reversibility in children?
Suxamethonium is often used for intubation prior to the use of a nondepolarizing muscle relaxant. This study was performed to determine whether suxamethonium altered the dose of alcuronium required to produce neuromuscular block. ⋯ Reversal with neostigmine was more rapid following 50 micrograms/kg than after 25 micrograms/kg. If recovery from neuromuscular block was greater than 25 per cent, the lower dose produced satisfactory reversal, whether or not suxamethonium had been given previously.
-
This paper reports the results of a prospective survey of 266 attempted central venous catheterisations by various routes, evaluating their success rate and incidence of immediate complications and attempts to demonstrate a relationship between patient height in centimetres (H) and ideal catheter length. The overall rate of intrathoracic placement was 230 from 239 catheterisations (96%) after 266 attempts (86%). Of these 230 catheters, 54 terminated in the right atrium (24%). To avoid right atrial placement with its well documented risk of cardiac tamponade, it is recommended that right infraclavicular subclavian catheters are inserted to H/10-2 cm, right internal or external jugular catheters to H/10 cm and left external jugular catheters to H/10 + 4 cm.
-
Epidural opioids have been used in obstetrics since 1980. Various opioids are reviewed in relation to their pharmacology, their efficacy in labour, during caesarean section and for postoperative analgesia, their side-effects and safety. In this patient population it appears safe to administer epidural opioids on the general ward provided that strict monitoring standards are maintained. Practical considerations of nursing management are discussed.
-
Anaesth Intensive Care · Aug 1990
ReviewEpidural medication after the initial dose: reflections on current methods of administration during labour.
Most women who receive epidural pain relief during labour require additional epidural analgesia following the initial dose. This review examines the relative merits associated with current methods of epidural drug delivery when further analgesia is required. Apart from considerations of patient safety and convenience the review compares the relative flexibility in pain management which can be provided by these different regimens. It is postulated that patient satisfaction is enhanced when the mother has some personal control over the density of neural blockade provided by epidural analgesia.