Anaesthesia
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Twenty-five patients underwent epidural anaesthesia with a new formulation of chloroprocaine 3% (1.0-1.5 ml x 10 cm body height-1) for a variety of day procedures. The mean (range) duration of surgery was 17 (5-35) min. ⋯ Two patients complained of severe backache immediately after operation and a further 16 and four patients reported mild or moderate backache respectively. Operating conditions were excellent in all but one patient and 23 patients said they would be happy to have the same anaesthetic again.
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Two hundred and five patients, aged 16-45 years, undergoing day care surgery were given a spinal anaesthetic using either a 26- or a 27-gauge Quincke point spinal needle. The occurrence of headache and accompanying symptoms postoperatively was analysed from 186 returned questionnaires. ⋯ The headache and accompanying symptoms were similar to that seen with a postdural puncture headache except that it was not aggravated by posture. A system of grading the severity of both type of headache is presented and standardised criteria for the classification of postdural puncture headache are proposed.
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The case notes and anaesthetic charts of 44 patients with dystrophic epidermolysis bullosa were reviewed retrospectively. A total of 390 general anaesthetics were performed for 469 surgical procedures over a 10-year period. Procedures included repair of syndactyly, dilatation of oesophageal strictures, extraction of teeth, excision of skin tumours and other procedures related to dystrophic epidermolysis bullosa. ⋯ Previous reports have suggested problems with the use of suxamethonium, nondepolarising muscle relaxants and thiopentone. These agents were all used in many of our patients without any adverse effects. There was one intra-operative death in a 35-year-old woman having an oesophageal dilatation which was complicated by oesophageal rupture.
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A 30-week newborn patient presented with acute respiratory obstruction due to a large pharyngeal teratoma. At laryngoscopy no view of the larynx was obtained, and a tracheal tube was unintentionally passed blindly into the oesophagus. This relieved the obstruction by anterior displacement of the mass.