Anaesthesia
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Aural canal temperature was measured for one hour after arrival in the recovery room in 200 adult patients who underwent one of the following types of major surgery: abdominal, pelvic, vascular, orthopaedic or prostatic. One group of 100 patients was studied in the recovery room of Hammersmith Hospital which was not equipped with a controlled system for constant ventilation and humidification, while the other 100 patients were studied in the recovery room of Edgware General Hospital, which had a constant ambient temperature and controlled relative humidity with 20 air changes/hour. ⋯ Within the range of ambient temperatures and relative humidities measured, patients over 60 years of age rewarmed more slowly than did patients under 60 years (p less than 0.05). General anaesthesia was associated with significantly faster rewarming than was local anaesthesia (p less than 0.01).
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A recent survey of Scottish obstetric anaesthesia practice revealed that the majority of deliveries take place in the larger hospitals; these also have the highest epidural rates, both for relief of pain in labour and for Caesarean section. However, as epidural blockade is an essential part of modern obstetric practice, it is a matter of concern to achieve an equal standard in the medium-sized hospitals, whilst accepting that special arrangements are required in the very small obstetric hospitals.
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Comparative Study
Profound atracurium induced neuromuscular blockade. A comparison of evoked reversal with edrophonium or neostigmine.
Speed of reversal of profound atracurium induced neuromuscular blockade following edrophonium (0.5 or 1.0 mg/kg) or neostigmine (0.04 or 0.08 mg/kg) was measured using the train-of-four pattern of nerve stimulation. In all patients adequate clinical reversal was present when the ratio of the strength of the fourth to the first twitch (T4 ratio) was 0.5. ⋯ However, the larger dose of neostigmine was associated with a reversal time approaching that of edrophonium. Possible explanations for these findings are discussed in terms of contemporary theories of neuromuscular pharmacology.
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We report a case of a young female who developed multiple life threatening complications after a single internal jugular vein catheterisation. They consisted of pleural misplacement of the catheter, massive haemorrhage with cardiovascular collapse following catheter removal, and development of arteriovenous fistula, diagnosed 18 months later.