Anaesthesia
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Randomized Controlled Trial Clinical Trial
Postoperative headache in young patients after spinal anaesthesia.
Spinal anaesthesia was performed on 247 young adult patients with a 25-G needle. Rectal administration of indomethacin had no significant effect on the incidence of postdural puncture headache, which occurred in 16.8% of patients who received the drug compared to 24.5% who received a placebo. A history of headache pre-operatively did not influence the incidence of postlumbar puncture headache.
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Case Reports
Respiratory depression after intrathecal opioids. Report of a patient receiving long-term epidural opioid therapy.
Morphine 20 mg and pethidine 50 mg were accidentally injected intrathecally in a patient who had received large doses of opioids epidurally for cancer pain and who had shown tolerance to their effects. The well established tolerance to spinal opioids did not protect the patient against a moderate degree of respiratory depression. Morphine concentrations 6.5 hours after the morphine injection were 103,500 ng/ml and 52 ng/ml in cerebrospinal fluid and serum, respectively.
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An historically prospective study of the rates of early retirement due to permanent ill health, early retirement between 60 and 64 years of age for other reasons, and deaths while in post, among consultant anaesthetists in England was carried out. The control group comprised consultants in four other hospital specialty groups. Approximately two-thirds of all consultants employed in the five specialties at National Health Service hospitals in England during 1966-83 were included in the study. ⋯ The number of deaths in post was also raised. For the smaller group of female anaesthetists there was not a statistically significant excess of ill-health retirements, but the number of early retirements between 60 and 64 was significantly greater than expected (p less than 0.005), as was the number of deaths in post (p less than 0.001). Possible causes of these excesses are discussed.
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A 67-year-old woman suffered cardiovascular collapse during induction of anaesthesia. This was later shown to be anaphylactic in origin; the causative agent was alcuronium. ⋯ Future anaesthesia with decreased risk was thereby assured. The clinical nature of this reaction and a review of the literature implicate the cardiovascular system as the principal target in this type of reaction to alcuronium and suggest that the heart is directly involved.