British journal of anaesthesia
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Percutaneous cannulation of the internal jugular vein in paediatric patients may be technically difficult and is prone to complications. To investigate the possibility that anatomical factors contribute to these difficulties, we used a two-dimensional ultrasound scanner to examine venous anatomy in children aged up to 6 yr. ⋯ We also evaluated the use of this ultrasound scanner during percutaneous central venous cannulation in neonates and infants. Determining the course of the internal jugular vein with the scanner and then marking it on the overlying skin reduced both the time and number of needle insertions required to aspirate jugular venous blood and increased the chance of a complication-free cannulation.
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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.
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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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Comparative Study
Long-term backache after extradural or general anaesthesia for manual removal of placenta: preliminary report.
A questionnaire designed to investigate the incidence of newly acquired, long-term backache was sent to women who had previously undergone manual removal of the placenta during a 12-month period in one maternity hospital. There was a significantly greater incidence of long-term backache in patients who had extradural anaesthesia specifically for manual removal of the placenta compared with patients receiving a general anaesthetic for the same procedure. The results of this retrospective study in a small population warrant examination in a large, prospective, controlled investigation.