Anaesthesia
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Randomized Controlled Trial Clinical Trial
Bupivacaine leak past inflated tourniquets during intravenous regional analgesia.
A small leak of bupivacaine was detected in 13 out of 52 cases (25%) during intravenous regional analgesia for the upper limb whilst the tourniquet cuff remained properly inflated. The plasma levels of bupivacaine (range 0.2-0.4 microgram/ml) were well below the toxic range, and no adverse sequelae resulted.
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The use of the new competitive muscle relaxant, atracurium, is described in five myasthenic patients presenting for thymectomy. With an initial dose of 0.1 mg/kg, that is approximately one-fifth of that normally used, and incremental doses of 0.02-0.04 mg/kg, satisfactory clinical conditions were achieved. ⋯ A marked increase in the magnitude of the first twitch of the train-of-four to greater than control levels, accompanied by pronounced fade, was found on reversal. In reduced dosage and with careful neuromuscular monitoring, atracurium is safe to use in the myasthenic patient.
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Case Reports
Ritodrine-induced pulmonary oedema in labour. Successful management using epidural anaesthesia.
A case is described in which unusually high doses of intravenous ritodrine were used for 6 weeks to postpone premature labour. Treatment was complicated by tachydysrhythmias and pulmonary oedema. Epidural analgesia was used successfully for pain relief during labour and Caesarean section. The pathophysiology is discussed.