Anaesthesia
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Case Reports
Spinal cord compression during chronic epidural morphine administration in a cancer patient.
A case is described of thoracic spinal cord compression that occurred during continuous epidural administration of morphine. Sensory loss and motor weakness in the legs disappeared after catheter removal and antibiotic treatment.
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An infant with Goldenhar's syndrome is presented in whom two-stage plastic surgery was undertaken. The first operation, at the age of 5 months, necessitated a retrograde technique for tracheal intubation while in the second, at 10 months of age, conventional intubation was possible. The discussion highlights those refinements that promote a successful outcome when retrograde intubation is indicated, particularly in infants.
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A study using postmortem dura mater demonstrated that rotation of the epidural needle significantly decreases the force required to puncture the dura. It is recommended that epidural needles should not be rotated after insertion of the tip into the epidural space.
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This case study emphasises the multiple factors that may be involved in the precipitation of electromechanical dissociation, which are compounded by additional problems that relate to pregnancy. It reinforces the value of the tracheal route for drug administration when a central vein is not cannulated and stresses the importance of posture and early consideration of Caesarean section in the pre-term gravid patient who has sustained a cardiac arrest.