Anaesthesia
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Clinical Trial Controlled Clinical Trial
Sensitivity to second dose of mivacurium.
The sensitivity of patients to a second dose of mivacurium has been studied following complete recovery of the twitch response after > 95% neuromuscular block produced by a systemic bolus of the drug. In further experiments we have excluded one arm from the effect of a systemic bolus ED95 dose of mivacurium for 100 s so as to obtain two different levels of neuromuscular block in the two arms of the same patient. ⋯ A similar increase in sensitivity was observed in the arm that had been excluded for 100 s from the peak effect of the drug. It was concluded that the second dose sensitivity was not due to a receptor effect or to residual drug in plasma.
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A previously fit 20-year-old man presented with a large haemothorax following a stab wound to the left chest. Pre-operative airway assessment indicated that tracheal intubation would be routine. ⋯ At operation, the patient's common carotid artery was found to have been perforated close to its origin on the aorta. The patient made an uneventful recovery.
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Case Reports
Emergency intubation through the laryngeal mask airway. The effective application of cricoid pressure.
A patient with Kugelberg-Welander disease presented as an unexpected difficult intubation. Tracheal intubation was achieved through the laryngeal mask airway, while regurgitation was prevented with continuous cricoid pressure. Regurgitation occurred after cricoid pressure was released.
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We performed a questionnaire survey to establish the current and intended practice of chair dental anaesthesia amongst recently appointed consultants, and senior registrars within the Mersey Region. Only 26% of the consultants surveyed practised chair dental anaesthesia, however, more consultants would have had their anaesthetic sessions allowed. Consultants performed 4.62 +/- 3.5 sessions per month and anaesthetised 8.0 +/- 2.27 patients per session. ⋯ Sixty-eight per cent of senior registrars declared an interest in chair dental anaesthesia. This group had received significantly more training (p < 0.005) in dental anaesthesia than those with no interest. Most anaesthetists (52/71) felt that chair dental anaesthesia was acceptable in centres approved to Poswillo standards; 16 anaesthetists felt that it should be confined to a hospital environment and three felt that it should not be performed at all.