Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialAntagonism of vecuronium paralysis: comparison between edrophonium and neostigmine.
The reversal of vecuronium paralysis was studied in three series of anesthetized (methohexital, fentanyl, N2O/O2) informed adult patients receiving either 40 micrograms/kg neostigmine (NEO40) (n = 6), either 500 micrograms/kg edrophonium (EDRO500) (n = 6) or 1000 micrograms/kg edrophonium (EDRO1000) (n = 6). These drugs were given randomly once the adductor pollicis twitch height regained 10% of its initial value. The neuromuscular transmission recovery was assessed during 15 minutes after the antagonist administration, by recording twitch height (TH), train of four--2 Hz--every 3 minutes (TOF Ratio) and finally tetanic fade--50 Herz (TET50) and 100 Hz (TET100), 5 seconds duration, one minute apart--. ⋯ At 100 Hz, the values were: NEO40 61% +/- 8, EDRO500 43 +/- 151 and EDRO1000 31 +/- 12 (p less than 0.01). In conclusion, in the conditions studied, 40 micrograms/kg neostigmine restores the neuromuscular transmission of the adductor pollicis at a higher level than edrophonium 500 micrograms/kg does. Edrophonium, 1000 micrograms/kg instead of 500 micrograms/kg does not change the neuromuscular transmission recovery.
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Acta Anaesthesiol Belg · Jan 1991
Case ReportsAmniotic fluid embolism during epidural anesthesia for cesarean section.
A survivor of a clinically severe presentation of amniotic fluid embolism during cesarean section performed under epidural anesthesia is presented. Some general pathophysiologic features of amniotic fluid embolism are discussed in the context of presented case: seizures as a first sign of amniotic fluid embolism, heart failure and coagulopathy. In addition we discuss the management of the epidural catheter in coagulopathy in the presented case.
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Acta Anaesthesiol Belg · Jan 1991
Case ReportsIntracranial subdural hematoma after spinal anesthesia.
We describe a 68-year old male patient with late onset signs of an intracranial subdural hematoma after repetitive spinal anesthesia procedures for urethral dilatation. The proposed mechanism is that of cerebrospinal fluid efflux. The potential for the development of such complications is so important, that it must be considered in every patient.
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The laryngeal mask (LM), a recently commercialized device, provides a totally patent airway when positioned in the hypopharynx. The major advantages of the LM are its ease of insertion, the absence of contact with the vocal cords, and the fact that if frees the hands of the anesthesiologist. Contraindications to its use result from its failure to seal the airway against regurgitation of gastric content. ⋯ Only 13% of patients complained of mild pharyngeal discomfort postoperatively. We conclude that this device is reliable, easy to use, and causes minimal postoperative problems. Its use, for both spontaneous and controlled ventilation, is increasing in our hospital.
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Acta Anaesthesiol Belg · Jan 1991
Intermittent femoral nerve blockade for anterior cruciate ligament repair. Use of a catheter technique in 208 patients.
The duration of postoperative analgesia following femoral nerve block with a catheter technique was studied. Intermittent doses of bupivacaine were given to 208 consecutive patients presenting for open repair of the anterior cruciate ligament, initially 0.5% and thereafter 0.25% 0.4 ml/kg 2-4 times daily. Supplementary analgesia with piritramide 0.15 mg/kg I. ⋯ Based on the duration of analgesia and on the number of analgesic demands required, good or satisfactory analgesia was obtained in 88% of the patients. The catheter remained an average of 2.8 days in position and no infectious or irreversible neurological complications were seen. It is concluded that femoral nerve block using a catheter technique, provides safe and reliable analgesia, improves patient mobility, has a high patient acceptance and is capable of reducing systemic analgesic demand following anterior cruciate ligament repair.