Anaesthesia
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Ten patients, undergoing elective orthopaedic surgery under spinal anaesthesia, were sedated with propofol using a closed-loop feedback control system. The bispectral index (BIS), a new processed EEG parameter, was used as control variable. ⋯ This feedback control system for propofol administration proved to be adequate and safe. BIS was found to be well suited as control variable.
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Case Reports
Systemic mastocytosis presenting as profound cardiovascular collapse during anaesthesia.
Mastocytosis is a rare disorder with serious anaesthetic implications. Anaesthetic management is hazardous since trauma, stress, extremes of temperature and drugs may precipitate intra-operative mast cell degranulation. ⋯ We present a case report of a patient with mastocytosis who suffered cardiac arrest during anaesthesia. Anaphylactoid/anaphylactic shock may be delayed and lack supporting signs of histamine release such as cutaneous flushing and bronchospasm.
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Latex is a ubiquitous part of life today. It is a constituent of many household products and medical devices, although not always obvious on examination. ⋯ Although there have been recent reviews of the general problem of latex allergy, there is little advice available to anaesthetists on how to develop an effective strategy to implement within their own hospitals. The aim of this article is to improve awareness of latex allergy and by describing the development of our strategy to identify and safely manage those at risk in the peri-operative period, facilitate the process for other departments.
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Sodium channel antagonists have been used in the management of neuropathic pain for several years. Recent evidence suggests that lamotrigine, which is active at glutaminergic excitatory synapses, is very effective in producing pain relief. ⋯ Our results suggest that this novel channel antagonist can be used to treat neuropathic pain. Double blind placebo control studies are therefore needed to substantiate these findings.