British journal of anaesthesia
-
The haemodynamic indices of three patients, who developed abdominal tamponade as a result of intra-abdominal bleeding following liver transplantation, were measured on four occasions as the increased intra-abdominal pressure was released. Hypotension followed the release of the tamponade in all patients and was the result of a decrease in systemic vascular resistance. ⋯ Treatment of hypotension following release of abdominal tamponade by volume replacement alone may be inappropriate and may lead to over-transfusion; adrenaline may be the treatment of choice. Intensive haemodynamic monitoring is advisable.
-
A nationwide follow-up survey was undertaken to study the use of extradural and intrathecal opioids in the management of pain, to estimate the incidence of delayed ventilatory depression and to study post-injection surveillance routines. A questionnaire was sent to all 93 anaesthetic departments in Sweden; 96% responded. The major indication for using extradural opioids was the treatment of postoperative, traumatic and cancer pain. ⋯ Risk factors for delayed ventilatory depression are discussed. Administration of extradural morphine for postoperative pain relief in patients undergoing major surgery is considered a high benefit-low risk technique by most Swedish anaesthetists. The results of the present nationwide survey suggests that, following extradural morphine, surveillance of patients for more than 12 h appears unnecessary.
-
In two groups of anaesthetized dogs, with (n = 28) or without (n = 28) induced intracranial hypertension, we compared the effects on intracranial pressure (ICP) of the rapid administration of mannitol 2 g kg-1 i.v. at PaCO2 2.7, 4.0, 5.3, and 6.7 kPa (n = 7). In dogs with no induced intracranial hypertension, ICP increased during the administration of mannitol, reached a peak at 2 min after infusion, and then gradually decreased (P less than 0.05). More marked changes in ICP were observed in response to higher values of PaCO2 (P less than 0.05). ⋯ This was followed by a more gradual decrease which achieved pre-balloon inflation values 10 min after infusion. We postulate that the absence of the initial increase in ICP is the result of a concomitant decrease in arterial pressure, a reduction in the volume-pressure response of the brain, the failure of mannitol to dilate further the cerebral arterial vascular bed and a hitherto unnoticed early water-drawing effect. Our study confirmed the safety of rapidly expanding the circulating blood volume with mannitol in circumstances of increased ICP in dogs.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Antagonism of vecuronium-induced neuromuscular blockade with edrophonium or neostigmine.
Antagonism of vecuronium-induced neuromuscular blockade was attempted, at varying degrees of spontaneous recovery, with edrophonium 0.5 mg kg-1 or neostigmine 0.05 mg kg-1 in two groups of 20 patients. Neuromuscular blockade was monitored using a train-of-four (TOF) stimulation. ⋯ While the time to onset of the action of edrophonium (22 s) was not significantly shorter than neostigmine (26 s), the time taken to attain a TOF ratio of 0.7 was significantly shorter with edrophonium (67 s compared with 194 s with neostigmine). It is concluded that edrophonium 0.5 mg kg-1 does not consistently antagonize vecuronium-induced neuromuscular blockade, particularly if there are three or less responses to a TOF stimulation present before antagonism.
-
Fifty-three infants with neural tube defects and 97 with other major congenital abnormalities have been reviewed. In only one case did the mother receive an anaesthetic before or during pregnancy and this anaesthetic is unlikely to have played any part in the outcome. The anaesthetic history was recorded for 471 mothers who booked consecutively for their confinements. ⋯ The corrected annual incidence of anaesthesia was about 20% (14% related to fertility). There were no fetal abnormalities, but two miscarriages in the women anaesthetized during pregnancy. There was one abnormal baby delivered to a women anaesthetized more than 12 weeks before the last menstrual period.