Anaesthesia
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In a prospective study of 51 young male outpatients given spinal anaesthesia through a 25-gauge needle, we found a 37.2% incidence of postdural puncture headache. In addition, 54.9% complained of backache after surgery. ⋯ These patients had a higher incidence of postoperative backache and pain during lumbar puncture. It is concluded that spinal anaesthesia is not a satisfactory technique for outpatient procedures in young men.
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Assessment of pain on injection of the emulsified formulation of di-isopropylphenol (propofol, 'Diprivan') was undertaken in 120 unpremedicated patients and comparison made with thiopentone. A high incidence of pain (37.5%) was found using dorsal hand veins, but use of forearm veins showed only a 2.5% incidence of pain. The use of intravenous lignocaine immediately before propofol injection only partially reduced the incidence of pain using dorsal hand veins (17.5%). A degree of cardiorespiratory depression accompanied induction but the incidence of other side effects was low.
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Four cases of air embolism which occurred during neurosurgical procedures in the sitting position are described, in whom the signs could be due to air in the coronary or cerebral arteries. It is suggested that, during venous air embolism in the sitting position, a significant number of patients are haemodynamically at risk from paradoxical air embolism, and that the serious consequences of venous air embolism in neurosurgery may be due to this.
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The history of tracheal intubation has been described before, but earlier accounts have overlooked several aspects and, in particular, the part played by Kuhn, who also deserves to be recognised for a number of other original contributions to anaesthesia.