Anaesthesia
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Case Reports
Intravenous regional analgesia. The danger of the congested arm and the value of occlusion pressure.
Two cases are described in which congestion of the arm occurred during intravenous regional analgesia. One case exhibited signs of serious local anaesthetic toxicity, while a significant plasma bupivacaine level was demonstrated in the other. In a study in a volunteer, leakage of contrast medium past the cuff was demonstrated radiologically only when congestion of the arm was produced. ⋯ Increases in arterial blood pressure occurring during the procedure can also lead to congestion of the arm. Congestion may increase the risk of local anaesthetic agent leaking past the tourniquet into the systemic circulation. Recommendations are made about the choice of cuff gauge pressure and the prevention of arm congestion occurring during intravenous regional analgesia.
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A case is reported of probable subdural injection of bupivacaine during attempted extradural analgesia for an operative obstetric procedure.
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Biography Historical Article
The Macintosh laryngoscope. A historical note on its clinical and commercial development.
It is 40 years since Sir Robert Macintosh discovered the principle of indirect elevation of the epiglottis and developed the laryngoscope which bears his name. The author celebrates the anniversary of this revolution in intubation with some notes on the early commercial history of the instrument and a description of a Longworth version made about 1945.
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A jet injector was used to perform intercostal nerve block as a method of intra-operative and postoperative pain relief at cholecystectomy, using a concentrated solution of local analgesic. This method was shown to be as successful as the conventional needle technique. The risk of pneumothorax, and the problems of the local analgesic solution used are discussed.