Anaesthesia
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Unusual case of brachial plexus palsy developed in a patient following general anaesthesia in the sitting position. Congenital skeletal anomalies together with severe bony degenerative changes surrounding the nerve roots probably precipitated the palsy.
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A simple modification to an existing adult ventilator has been designed to permit mechanical ventilation of neonates and small children with the Ayre's T-piece circuit. The Nuffield Anaesthesia Ventilator Series 200 has been modified by replacing the piston in the patient valve with a fixed leak. ⋯ The modified ventilator is shown to perform as a time-cycled pressure generator capable of delivering tidal volumes between 10 and 300 ml at frequencies from 10 to 85/minute. It is therefore ideally suited to neonatal and paediatric use.
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Case histories of three patients with intractable pain, all of whom responded to epidural morphine, are presented. Drug tolerance appeared to develop in two patients who survived longer than 10 days. Nevertheless this method of pain relief may be a useful adjunct to terminal care and in certain circumstances may allow for easier management in the patient's own home.