Anaesthesia
-
Case Reports
Epidural anaesthesia, ephedrine and phenylephrine in a patient taking moclobemide, a new monoamine oxidase inhibitor.
We report a case of low thoracic epidural and general anaesthesia in a patient receiving moclobemide, a new selective inhibitor of monoamine oxidase A. Intra-operative hypotension was initially treated with phenylephrine and then with ephedrine. The short half-life of moclobemide and its modest interaction with direct and indirect acting sympathomimetic drugs permit the use of epidural anaesthesia, since any associated hypotension can be safely treated.
-
The ventilation-exchange bougie is a new airway device which can be mounted on a fibreoptic laryngoscope for passage through the larynx into the trachea via a laryngeal mask airway. Subsequent removal of the fibreoptic laryngoscope and laryngeal mask airway allows a tracheal tube to be railroaded into position over the ventilation-exchange bougie. This study described the use of this technique for elective tracheal intubation in two groups of 12 subjects in whom difficulty with intubation was not expected. ⋯ Cusum analysis confirmed the impression of a learning curve and the technique could be considered learnt after four and six intubations for the experienced and inexperienced fibreoptic laryngoscopists respectively. No difficulty was found either in intubating the larynx with the fibreoptic laryngoscope and ventilation-exchange bougie or when railroading the tracheal tube over the ventilation-exchange bougie. It is suggested that this new device could have an important role in teaching fibreoptic techniques, management of the difficult airway and failed intubations.
-
We describe the effects of accidental intra-arterial injection of suxamethonium and atracurium into the femoral artery of an infant. An 11-month-old boy with Downs Syndrome and obstructive sleep apnoea presented for tonsillectomy. Peripheral venous cannulation proved impossible. ⋯ Within 30 min there was marked vasodilation of both legs with easily felt peripheral pulses. In view of the tonsillectomy anticoagulant and thrombolytic therapy were contra-indicated. There were no adverse sequelae.