Anaesthesia
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In 30 ASA 1 and 2 patients undergoing general anaesthesia and neuromuscular paralysis, manual in-line stabilisation of the neck in a neutral position was performed and single-handed cricoid pressure was applied. Vertical displacement was measured from the midpoint of the neck (directly below the cricoid cartilage). Measurements were also made at the tragus of the ear and the shoulder; both of which acted as fixed reference points. ⋯ Single-handed cricoid pressure caused vertical displacement of the neck of between 4.6 and 5 mm with a range of 0-9 mm. Only some of this movement, i.e. 0.5-0.9 mm (range 0-2mm) can be accounted for by displacement of the whole patient as determined from measurements at the two fixed reference points. These findings have implications for emergency management of the airway in trauma patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesic effect of intrathecal neostigmine and its influence on spinal anaesthesia.
A clinical trial was conducted to evaluate the postoperative analgesic efficacy and the safety of intrathecal neostigmine in patients undergoing anterior and posterior vaginoplasty under spinal anaesthesia. Thirty-six patients were randomly divided into three groups to receive: normal saline (1 ml), morphine (100 micrograms in 1 ml of saline) or neostigmine (100 micrograms in 1 ml of saline) intrathecally just before a spinal injection of hyperbaric bupivacaine (0.5%, 4 ml). The mean [SD] time to the first analgesic (nonsteroidal anti-inflammatory drug) administration was significantly prolonged by intrathecal neostigmine (10.7 [4.3] h) and morphine (15.3 [3.0] h) compared with saline (4.5 [1.0] h). ⋯ Severe nausea and vomiting, sweating and distress during surgery were the most obvious adverse effects of intrathecal neostigmine. On the other hand, less hypotension was observed in the neostigmine group. The usefulness of intrathecal neostigmine as the sole postoperative analgesic may be restricted by the severity of its adverse effects.