British journal of anaesthesia
-
Case Reports
Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch.
Puerperal women are reported to have a rate of cerebral infarction 13 times greater than non-pregnant females. We report a case of cerebral ischaemia in a 30-yr-old healthy parturient after epidural analgesia for labour, complicated by dural puncture treated with two epidural blood patches. ⋯ At 1-yr follow-up, the patient had homonymous hemianopsia. We discuss the possible causative mechanism of the cerebral ischaemia in relation to the dural puncture and epidural blood patch.
-
Comparative Study
Cerebrospinal fluid and blood propofol concentration during total intravenous anaesthesia for neurosurgery.
The aim of this paper is to compare the propofol concentration in blood and cerebrospinal fluid (CSF) in patients scheduled for different neurosurgical procedures and anaesthetized using propofol as part of a total intravenous anaesthesia technique. ⋯ Intracranial pathology may influence CSF propofol concentration. However, the observed discrepancies may also result from quantitative differences in CSF composition and from restricted diffusion of the drug in the CSF.
-
Caudal analgesia is widely used in paediatric anaesthetic practice. In adults, the 'whoosh' test has been recommended as a guide to successful needle insertion, but it has not been extensively studied in paediatric patients. We have investigated a modification of the 'whoosh' test, which we have christened the 'swoosh' test. It avoids the injection of air by performing auscultation during injection of the local anaesthetic solution. We have compared it with clinical judgement of correct placement. ⋯ The 'swoosh' test is a simple and accurate test to confirm successful caudal insertion in children, and is especially useful as a teaching aid for anaesthetists new to the technique.