Anaesthesia
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Sixty-six of a series of 116 patients had a postural headache resulting from an inadvertent dural puncture (despite in 64 cases the provision of an epidural drip) and 50 had headache following a spinal block. Experience suggested that it is advisable to inject 20 ml of blood unless during the course of injection the patient complains of pain or discomfort. ⋯ In only one patient (who had three dural punctures) of the 98 so treated has the patch failed to relieve the headache. Arguments are presented against the use of a prophylactic patch, and against utilisation of the epidural catheter as a route for injecting the patch.
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A case of cardiac arrest during moderate hypothermia and profound hypotension following rupture of a cerebral aneurysm is described. The patient survived with few neurological sequelae directly attributable to the period of cerebral ischaemia. The protective effect of hypothermia in the prevention of neurological damage is illustrated as are the difficulties of resuscitation.
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A retrospective examination of all maternal deaths at Queen Charlotte's Hospital in the last 20 years shows that general anaesthesia is the greatest single cause of maternal death. This highlights the need for considerable reduction in the inherently dangerous technique of general anaesthesia to patients in labour and, where possible, its replacement by extradural and spinal blocks.
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A patient who reacted to both methohexitone and Althesin on separate occasions is described. On each occasion the reaction was delayed following anaesthesia. Underlying chronic infection had sensitised the patient's complement pathway, allowing it to be activated by two unrelated intravenous anaesthetic agents.