Anaesthesia
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Clinical Trial Controlled Clinical Trial
Topical analgesia before tracheal intubation.
The major toxic effects of local analgesic drugs are regarded as due to over-dosage. A technique of topical analgesia for tracheal intubation using lignocaine is described based on spraying the pyriform fossae to effect a superior laryngeal nerve block combined with topical analgesia of larynx and trachea which avoids excessive exposure of the lowere airway to the local analgesic. The results show lower levels of venous blood lignocaine with slower absorption of the agent than when similar doses are applied to the trachea. This method is accordingly recommended.
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A case of neurological damage associated with lumbar epidural block is presented. Muscle paralysis and sensory loss were found in the immediate postoperative period and there was partial recovery of muscle power. The possible mechanisms of nerve damage are discussed.
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This study reports pupillary changes occurring in seventeen of twenty pregnant women at term who received caudal analgesia for the relief of pain in the first and second stages of labour. It is suggested that 10 ml or more of analgesic solution, injected into the sacral epidural space, reaches high enough (probably to T1) to cause meiosis and/or ptosis.
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A specially designed 20 ml syringe for eliciting the loss of resistance test is described together with a suitably adapted Tuohy needle. This syringe and needle are primarily intended for use by those gaining experience in extradural analgesia (and such experience is readily transferred to any syringe) but it is considered that the consummate ease of operation will be appreciated by others.
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The management of a patient is described who has a blood patch for spinal headache, but who had a recurrence of symptoms 1 day later which was successfully treated by a second patch. A second case is described in which there was a second dural puncture immediately prior to the blood patch and, immediately following the blood patch, the patient complained of severe debilitating 'paralysing' pain in both legs. This pain was of short duration and the blood patch was successful. Some further observations on the use of a blood patch are recorded.