Anaesthesia
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Summary We report on airway complications associated with general anaesthesia in a subject who had been exposed to CS spray several hours before surgery. CS spray is a form of tear gas that is said to have a short half-life when the subject is removed from exposure. Induction of anaesthesia was uneventful. ⋯ The effects on the attending anaesthetist made tracheal re-intubation difficult. There were no long-term adverse sequelae for the patient or anaesthetists. Suggestions are made for changes to anaesthetic practice and the advice given by the police about patients who have been exposed to CS spray.
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Case Reports
Use of alpha-agonists for management of anaphylaxis occurring under anaesthesia: case studies and review.
Anaphylaxis is an uncommon but serious complication of anaesthesia. Most current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of cardiovascular collapse. We present two cases of anaphylaxis under anaesthesia where return of spontaneous circulation was refractory to epinephrine, but occurred following the administration of the alpha-agonist metaraminol. Potential advantages and disadvantages of using epinephrine in this setting, the role of alpha-agonists and some potential mechanisms accounting for their role in successful management are reviewed.
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The history of the design of spinal needle tips is discussed, from the first needles used by J. Leonard Corning in 1885 to innovative, modern needle designs that continue to appear on the market. The shape of the needle tip started as a cutting bevel and developed into the atraumatic tip and the pencil-point tip in current common use. Innovative designs such as the stylet-tipped needle and the directional needle are described, as well as the needles used for continuous spinal anaesthesia.