Anaesthesia
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Difficulty was encountered during extubation due to a fold in cuff of a tracheal tube at its distal end. Management of this unexpected and rare complication is described.
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A method of total intravenous anaesthesia for neurosurgery and neuroradiology is described using a continuous infusion of alphaxalone/alphadolone (Althesin) with analgesics and muscle relaxants. It has been used successfully on 272 occasions in 243 patients. The reasons for using such a technique and the advantages and disadvantages inherent in it are discussed.
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Sixty-six of a series of 116 patients had a postural headache resulting from an inadvertent dural puncture (despite in 64 cases the provision of an epidural drip) and 50 had headache following a spinal block. Experience suggested that it is advisable to inject 20 ml of blood unless during the course of injection the patient complains of pain or discomfort. ⋯ In only one patient (who had three dural punctures) of the 98 so treated has the patch failed to relieve the headache. Arguments are presented against the use of a prophylactic patch, and against utilisation of the epidural catheter as a route for injecting the patch.