Anaesthesia
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A method of intra-operative awakening which allows assessment of spinal cord function during Harrington rod spinal fusion for scoliosis is described. The anaesthetic technique is based on a standard muscle relaxant, N2O anaesthetic sequence supplemented with intravenous morphine 0.1 mg/kg at the commencement of surgery and 0.2 mg/kg intramuscular premedication. ⋯ Five patients remembered being woken, but did not regard it as unpleasant. In one patient, this technique allowed intra-operative detection and correction of impaired motor function of the legs.
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Randomized Controlled Trial Clinical Trial
Droperidol and endotracheal intubation. Attenuation of pressor response to laryngoscopy and intubation.
The cardiovascular responses to anaesthesia, laryngoscopy and tracheal intubation were studied in 20 healthy adult patients. The mean arterial pressure increase following intubation was 1.60 mmHg (SEM +/- 3.52 mmHg) in patients to whom droperidol 150 microgram/kg was given intravenously before anaesthesia compared with a rise of 26.50 mmHg (SEM +/- 4.35 mmHg) in a control group of patients.
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Tracheal intubation with the aid of the fibre-optic bronchoscope was compared to conventional and alternative methods in 41 consecutive patients suffering from advanced rheumatoid arthritis. All patients were scheduled for anterior and/or posterior cervical fusion. ⋯ The occurrence of postoperative upper airway oedema was significantly related to the extent of the intubation trauma. Tracheal intubation with the fibre-optic bronchoscope is considered useful in adult patients when intubation is expected to be difficult or dangerous and when orthodox intubation is found to be very difficult.
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A patient is reported who developed suxamethonium apnoea as a result of reduction in serum cholinesterase activity secondary to both pregnancy and plasmaphoresis. Had the enzyme studies been carried out before operation, regional rather than general, anaesthesia would have been used. In order to avoid the problems associated with prolonged paralysis we recommend the measurement of cholinesterase activity in all patients who have undergone plasmaphoresis and in whom anaesthesia involving the use of suxamethonium is contemplated.