Anaesthesia
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Case Reports
Cardiorespiratory arrest following combined spinal epidural anaesthesia for caesarean section.
A 31-year-old woman had an elective Caesarean section under combined spinal/epidural anaesthesia. At the end of the operation, diamorphine 2.5 mg in 5 ml of 0.25% bupivacaine plain was injected through the epidural catheter. Forty minutes after this, the patient had a cardiorespiratory arrest in an ordinary postnatal ward.
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This study examined the effectiveness of a new type of chest drain, which incorporates an additional lumen within its wall to facilitate the administration of intrapleural bupivacaine. Nine patients who received a bolus dose of 1.5 mg.kg-1 bupivacaine with 1:200,000 adrenaline through this chest drain used less morphine, and had lower visual analogue pain scores in the first 6 h after thoracotomy than patients in whom a standard chest drain had been used. Bupivacaine levels were found to be within safe limits in all patients.
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This study evaluates whether the pulse oximeter is useful during cardiopulmonary resuscitation. The instrument was of undoubted benefit in the management of primary respiratory arrest, but of equivocable value in cardiac arrest. ⋯ The ear probe was not able to produce a consistently good signal during cardiopulmonary resuscitation. Nevertheless, the provision of an oximeter amongst the first-line resuscitation equipment available at a cardiopulmonary arrest significantly altered the management of seven out of 20 patients, five of whom survived.
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The anatomy of the lumbar plexus and the various approaches used to perform lumbar plexus blockade are reviewed. A single needle technique for a posterior approach to the plexus at the L2-3 interspace is described. This technique was used bilaterally in six intact cadavers, and the extent of spread of an injected dye was documented photographically during a subsequent detailed dissection of the region. ⋯ No dye was seen anterior to the psoas, around the sympathetic chain, on the sacral plexus or in the extradural or subarachnoid spaces. Further studies in patients with needle position and drug disposition being confirmed using computerised tomography and X ray scanning were in agreement with the results observed in the cadavers. This technique represents a simple approach to the lumbar plexus which does not require needle localisation by X ray screening.