British journal of anaesthesia
-
Editorial Comment
Postoperative residual curarization and evidence-based anaesthesia.
-
Use of an epidural blood patch to treat spinal headache after accidental dural puncture is well recognized. The high success rate associated with this practice has been questioned and it is not uncommon for patients to suffer recurring headaches after a supposedly successful blood patch. We describe a patient in labour who suffered accidental dural puncture, and whose headache was treated twice with an epidural blood patch. ⋯ The case highlights the difficulty in the diagnosis of headache in the postnatal period in patients who have had regional analgesia and the importance of considering an alternative pathology, even if epidural blood patching has been successful. In this case, a diagnosis of cortical vein thrombosis was made. The incidence, presentation, aetiology and treatment of this rare condition is described.
-
We have investigated residual block after anaesthesia which included the use of the neuromuscular blocking agent vecuronium but no anticholinesterase, in 568 consecutive patients on admission to the recovery room. The ulnar nerve was stimulated submaximally using TOF stimulation (30 mA). Postoperative residual curarization was defined as a TOF ratio < 0.7. ⋯ In the remaining 139 patients, neuromuscular block was successfully antagonized. Only 20 patients (3.5%) remembered TOF stimulation when questioned 2 h later in the recovery room, and discomfort associated with it was assessed using a visual analogue scale before discharge. We conclude that it is necessary to antagonize residual block produced by vecuronium.
-
The neurological complications of cardiac surgery are associated with significantly increased mortality, morbidity and resource utilization. The use of new surgical techniques, introduction of wider indications for surgery and increased public expectation has led to an increase in the average age of cardiac surgical patients and an increased incidence of repeat procedures. With these changes has come an increased risk of neurological complications. ⋯ Despite these measures, a small number of patients will inevitably sustain cerebral injury during otherwise successful cardiac surgery. Although pharmacological neuroprotection may, in the future, offer some of these patients an improved outcome, it is unlikely that any single agent will prevent neurological injury. In the meantime, the CNS complications of cardiac surgery remain a fertile area of research.