British journal of anaesthesia
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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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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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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 measured the effects of 0.5, 1.0 and 1.5 MAC (minimum alveolar concentration) end-tidal concentrations of sevoflurane on intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), central venous pressure and heart rate in hypocapnic dogs (PaCO2 3.2-3.7 kPa) and compared the data with those produced by equi-MAC concentrations of enflurane and halothane. Enflurane and halothane caused small but significant increases in ICP at 0.5, 1.0 and 1.5 MAC, but there were no changes with sevoflurane. However, sevoflurane caused a considerable decrease in MAP with consequent decrease in CPP. We conclude that sevoflurane should be a suitable agent for neuroanaesthesia and is preferable to either enflurane or halothane.