Anaesthesia
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Case Reports
Cardiac arrest and resuscitation of a 6-month old achondroplastic baby undergoing neurosurgery in the prone position.
We describe the case of a 6-month-old achondroplastic baby who underwent foramen magnum decompression to relieve congenital cervical cord compression. During the procedure, acute hypotension occurred secondary to cord compression, and following attempts to alleviate this, torrential haemorrhage ensued and air was entrained into the circulation through large venous channels in the surgical field. This resulted in an asystolic cardiac arrest from which the baby was resuscitated whilst remaining in the prone position. ⋯ In total, 11 min elapsed before an adequate spontaneous cardiac output was re-established. The procedure was abandoned and the patient transferred to the intensive care unit for postoperative management. An electroencephalogram performed after 24 h was reported as normal, and clinically the child made a full neurological recovery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia with transdermal fentanyl following lower abdominal surgery.
In a randomised, placebo-controlled, double-blind study involving 81 patients undergoing total abdominal hysterectomy, the postoperative analgesia provided by transdermal fentanyl given at 25, 50, or 75 micrograms.h-1 for 72 h was compared with a placebo group. The efficacy of the Transdermal Therapeutic System was related to the rate of fentanyl delivery, higher rates being associated with significantly lower visual analogue pain scores (24, 20, 17 and 13, for placebo, 25, 50 and 75 micrograms.h-1 respectively) and reduced patient controlled analgesia morphine requirements (44, 38, 33 and 31 mg respectively). Patients' overall sedation scores were not increased by transdermal fentanyl, but respiratory rates decreased with higher transdermal fentanyl dosage.
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Comparative Study Clinical Trial Controlled Clinical Trial
Edrophonium as an antagonist of vecuronium-induced neuromuscular block in the elderly.
Train-of-four stimuli were applied to the ulnar nerve using an accelograph in 10 elderly patients (aged 70-82 years) and 10 younger patients (aged 27-54 years). Anaesthesia was induced with thiopentone 5 mg.kg-1 and was maintained with nitrous oxide (66%) oxygen and sevoflurane (1 MAC). Vecuronium 0.1 mg.kg-1 was used for paralysis, and reversed with intravenous edrophonium 0.75 mg.kg-1 and atropine 0.015 mg.kg-1 when the train-of-four ratio returned to 25%. ⋯ The reversal times from 25% to 75% of the train-of-four ratio after the administration of edrophonium were 210.0 (SD 136.7) s and 177.0 (SD 100.4) s in the elderly and younger patients, respectively. There was no statistically significant difference between them. The authors were unable to show that healthy elderly patients differ significantly from younger patients in the neuromuscular blocking effect of vecuronium and the reversal effect of edrophonium.
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A case of venous air embolism during awake craniotomy is described. Chest pain and electrocardiographic changes were the major presenting features. Capnography detected a decrease in end-tidal carbon dioxide and demonstrates its use as an aid in the diagnosis of air embolism in the awake patient. Following this episode persistent hypoxaemia developed secondary to acute pulmonary oedema and a pleural effusion.
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Letter Case Reports
Fentanyl-induced laryngospasm following tracheal extubation in a child.