Anaesthesia
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The Duostim model TV02 is a new peripheral nerve stimulator designed both for nerve identification in the performance of regional anaesthesia and for monitoring neuromuscular blockade. The output pulses are unipolar and of adjustable constant current. The provision of single twitch (1 Hz and 1/15 Hz) train-of-four and tetanic stimuli, together with indication of the current delivered and the small size of the unit, facilitate its clinical use. Performance was assessed and found to be according to specification.
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The management of a persistent, incapacitating postdural puncture headache that required four consecutive autologous epidural blood patches is presented. Inadequate blood volumes, early patching and steroid in the epidural space are considered as possible causes of failure. Other associated problems and interventions are briefly discussed.
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The 'locked-in' syndrome has not previously been described in the immediate period after open-heart surgery. We describe the case of a patient who remained tetraplegic and mute, but alert, after graft surgery. A brief review of the aetiological factors in the development of this type of stroke after coronary artery bypass is presented.