Anaesthesia
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We describe a previously unreported test to confirm accurate needle placement in caudal epidurals. Of 26 patients undergoing caudal epidural, 19 (73%) had correct needle placement as determined by epidurography. All of these had a positive 'whoosh' test. There were no false positives.
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This paper reports previously unpublished accounts of the deaths in 1915 and 1919 of two members of the same family during general anaesthesia. The deaths were subsequently ascribed to a 'hereditary susceptibility' to chloroform. Contemporary evidence is presented which suggests that these deaths were among the very earliest examples of malignant hyperthermia to be described.
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An 18-year-old girl received isoflurane sedation for 48 h to facilitate mechanical ventilation. This resulted in a serum inorganic fluoride level of 37.3 mumol.l-1 when the isoflurane was stopped. As the serum fluoride level may continue to rise after isoflurane and as this level is approaching toxicity, the role of isoflurane sedation in the critically ill should be approached cautiously.
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Episodes of desaturation were recorded simultaneously by computer from two Ohmeda Biox 3700 pulse oximeters, one with an ear and one with a finger probe, on patients undergoing anaesthesia. Over a period of 6 months, 28 episodes of desaturation were detected. ⋯ Analysis at different saturation levels showed finger probe responses to be significantly slower than ear probe responses at saturations equal to and above 91% (p less than 0.05). At saturation levels of 90% or less no significant difference in probe response times were found.
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This study was undertaken to examine the effects of nicardipine on circulatory responses to laryngoscopy and tracheal intubation in normotensive (n = 39) and hypertensive (n = 36) patients. Laryngoscopy and tracheal intubation were performed after induction of anaesthesia with thiamylal, followed by administration of intravenous saline or nicardipine 20 or 30 micrograms.kg-1 and suxamethonium. Blood pressure and heart rate were recorded, and rate-pressure product was calculated. ⋯ The changes in heart rate after intubation were significantly greater in normotensive patients than in hypertensive patients when 20 or 30 micrograms.kg-1 of nicardipine was given (p less than 0.05 and p less than 0.01 respectively). Rate-pressure product increased significantly (p less than 0.01) after intubation in normotensive patients whether nicardipine was administered or not, but the increase was suppressed completely by nicardipine 20 or 30 micrograms.kg-1 in hypertensive patients. We conclude that nicardipine is effective in preventing the circulatory responses to laryngoscopy and tracheal intubation in hypertensive patients.