Anaesthesia
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Sciatic nerve block was performed in two groups of patients using a low power peripheral nerve stimulator to aid nerve location. In group A 1% prilocaine with felypressin was used as the local anaesthetic agent in a volume of 0.25 ml/kg body weight. ⋯ Use of the 3% solution resulted in highly significant reductions in the mean latency for analgesia of the nerve block and in the latency and degree of motor block achieved (p less than 0.005 in each case). The clinical value of high concentration, low volume nerve block is discussed.
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Comparative Study
Respiratory depression in children at different end tidal halothane concentrations.
Respiratory motor function and timing were investigated at end tidal halothane concentrations of 1.5%, 1.0% and 0.5% before and during 4% carbon dioxide stimulation in 10 spontaneously breathing children who weighed between 10.2 and 25.2 kg, during hypospadias repair under halothane anaesthesia. Their tracheas were intubated and all received a caudal block to eliminate surgical stimulation. Pneumotachography and capnography were used and in three cases movements of ribcage and abdomen were also studied by magnetometers. ⋯ Respiratory timing was unaltered by carbon dioxide stimulation. It is concluded that the ventilatory motor response to carbon dioxide is dose dependent and improves at more superficial anaesthetic levels, while respiratory timing is unresponsive to carbon dioxide stimulation irrespective of the halothane concentration used. Paradoxical breathing existed at end tidal halothane concentrations higher than 1%.
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A patient required respiratory support with jet ventilation via a minitracheotomy tube 2 days after right upper lobectomy. After initial improvement, the patient's condition deteriorated because of migration of the minitracheotomy tube out of the larynx. This complication has not been described previously. A number of possible causative factors and remedies are discussed.