British journal of anaesthesia
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Case Reports
Delayed presentation of an extradural abscess complicating thoracic extradural analgesia.
Extradural abscess is a rare but recognized complication of extradural anaesthesia. Previous reports have been associated with a short time interval between extradural catheterization and presentation. We report a patient with rheumatoid arthritis, receiving steroid therapy, in whom an extradural abscess did not present until 23 days after the insertion of a thoracic extradural catheter to provide postoperative analgesia.
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The applied anatomy of the cricothyroid and cricotracheal region of the neck and a retrograde method of tracheal intubation using the subcricoid region are described. This approach has several advantages, including absence of bleeding complications, as there are no major blood vessels on the cricotracheal membrane, and reduction in the possible development of subglottic oedema and stenosis.
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Randomized Controlled Trial Clinical Trial
Effect of addition of hyaluronidase to bupivacaine during axillary brachial plexus block.
We have studied in 22 patients the effect of adding hyaluronidase to bupivacaine during axillary brachial plexus block (BPB) in a double-blind design. Patients received BPB using bupivacaine 2 mg kg-1 with adrenaline 1 in 200,000, either with or without hyaluronidase 3000 iu, in a volume of 0.5 ml per 2.54 cm of the patient's height. ⋯ Hyaluronidase produced a significant reduction in the duration of anaesthesia. Changes in grip strength and skin temperature were useful in assessing the onset and progress of BPB.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of verapamil on the cardiovascular responses to tracheal intubation.
We have studied the efficacy of verapamil in attenuating the cardiovascular responses to tracheal intubation in three groups of ASA grade I patients given verapamil 0.05 mg kg-1 or 0.1 mg kg-1 or saline 45 s before the start of laryngoscopy. Anaesthesia was induced with thiopentone 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. ⋯ In patients who received saline, there was a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. The increases were significantly less in verapamil-treated patients compared with those in the control group, although verapamil failed to prevent tachycardia caused by laryngoscopy and intubation.