British journal of anaesthesia
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Plasma concentrations of bupivacaine have been measured in 12 patients given bupivacaine through a paravertebral catheter placed under direct vision at thoracotomy. After an initial bolus of 0.5% bupivacaine 20 ml, mean (SEM) Cpmax was 1.45 (0.32) micrograms ml-1 and median (range) tCpmax was 25 (10-60) min. ⋯ No symptoms or signs of toxicity occurred. Separate measurement of R- and S-bupivacaine concentrations demonstrated significantly different concentration-time profiles.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neostigmine and edrophonium antagonism of moderate neuromuscular block induced by pancuronium or tubocurarine.
Edrophonium and neostigmine are anticholinesterase drugs used commonly to antagonize competitive neuromuscular block. Although it has a faster onset of action than neostigmine, edrophonium is unreliable when used to antagonize deep neuromuscular block. We have compared the antagonist characteristics of these two drugs when used to antagonize a moderate degree of pancuronium- or tubocurarine-induced neuromuscular block. ⋯ Adequate recovery was defined as the achievement of a TOF ratio of 0.70 or greater. Only seven of 20 patients who received edrophonium demonstrated adequate recovery 30 min after antagonism. Under the conditions described in this study, edrophonium 0.5 mg kg-1 was less effective as an antagonist than neostigmine 0.05 mg kg-1.
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We describe a case of post lumbar puncture headache treated by extradural blood patch. Magnetic resonance imaging (MRI) demonstrated a large extradural haematoma extending over four spinal segments and extending out through the neural outlet foramina. There was significant compression of the thecal sac, supporting the theory that extradural blood patch causes tamponade at the site of dural puncture. The spread of clot was predominantly upwards from the injection site and subarachnoid extension of blood was also demonstrated.
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Biography Historical Article
John Henry Hill Lewellin: the first etherist in Glasgow.
John Henry Hill Lewellin, a surgeon-dentist, was the first to administer ether in Glasgow, on January 4, 1847. He was born in Calcutta, trained at St Bartholomew's Hospital, qualified M. R. ⋯ He remained there for about 18 months, advertising his dental practice in a high profile manner and, when the time came, he publicized his experience with ether in the local press in an exemplary way. He disappeared from Glasgow in June 1847, and reappeared in Australia 5 years later, practising as a dentist initially, and later as a general medical practitioner in Melbourne until his retirement in 1883. He died in 1886.