British journal of anaesthesia
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Case Reports
Surgical emphysema and upper airway obstruction complicating recovery from anaesthesia.
We describe a case of surgical emphysema and life-threatening airway obstruction resulting from a small pharyngeal perforation. The perforation apparently resulted from the use of a Yankauer-type sucker after uneventful anaesthesia for stapedectomy.
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We have studied the neuromuscular effects of pipecuronium, vecuronium and their combination in 130 ASA group I or II patients. Patients were anaesthetized with 0.8% halothane and 60% nitrous oxide in oxygen. Neuromuscular block was recorded as the evoked thenar mechanomyographic response to train-of-four stimulation of the ulnar nerve (2 Hz at 10-s intervals). ⋯ The calculated doses producing 50% depression of the first twitch height were 15.6, 16.9 and 15.0 micrograms kg-1 for the pipecuronium, vecuronium and pipecuronium-vecuronium combination groups, respectively. Isobolographic and algebraic (fractional) analyses were used to assess quantitatively the combined neuromuscular effect of pipecuronium and vecuronium and to define the type of interaction between these drugs. The interaction between pipecuronium and vecuronium was found to be additive.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous subcutaneous infusion of morphine--an alternative to extradural morphine for postoperative pain relief.
In a randomized, double-blind study of 40 patients undergoing total abdominal hysterectomy, we have compared continuous subcutaneous infusion (CSCI) of morphine with discontinuous extradural injection of morphine for postoperative analgesia at rest and during cough. The CSCI group received a bolus of morphine 0.1 mg kg-1 i.v. at the end of the operation and continued with s.c. infusion of morphine 30 micrograms kg-1 h-1. The extradural group received morphine 4 mg extradurally at 0, 2, 10 and 18 h after operation. ⋯ No significant difference was observed between the groups regarding supplementary doses of morphine, peak expiratory flow values or side effects. We conclude that morphine by CSCI is not as effective as morphine injected extradurally. However, CSCI seems to provide simple and relatively effective analgesia with a low rate of side effects.
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We have used the single space combined spinal-extradural technique for mothers requesting analgesia in labour. Intrathecal plain bupivacaine 5 mg produced a median time to analgesia of 3 min. There was inadequate abdominal analgesia after 10 min in 16% of recipients, although all had good perineal analgesia. ⋯ There were no post-spinal headaches. This technique is suitable for those parturients requesting analgesia in active labour who may not have time to achieve extradural analgesia before delivery. The extradural catheter is used to improve analgesia if the subarachnoid block is inadequate, or if labour continues beyond the duration of the subarachnoid block.
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We have compared deep body temperature (DBT) measured at the forehead with the core temperatures of the nasopharynx, oesophagus and rectum during the warming phase of cardiopulmonary bypass (CPB) (moderate hypothermia of 26.7-29.6 degrees C) in 12 patients. DBT was measured transcutaneously by an insulated thermistor probe that created an area of zero thermal flow between skin and subcutaneous tissue. ⋯ Among all measurements, the closest linear relationship was found between forehead DBT and nasopharyngeal core temperature (0.99 x nasopharyngeal temperature (degrees C) -0.07; SEE = 0.53; r = 0.99; P < 0.0001). Forehead DBT measurement may be useful as a reliable non-invasive method of monitoring cerebral temperature during CPB.