South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Case Reports
Fracture-dislocation of the lumbosacral spine during a grand mal epileptic seizure. A case report.
A patient with a lumbosacral fracture-dislocation is described. This serious injury can easily be missed; it is caused by severe trauma and multiple injuries are often present. Radiological examination should include the cervical, thoracic, lumbar and sacral vertebrae as well as the pelvis.
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Twenty-three patients undergoing a wide variety of neurosurgical procedures were anaesthetised using fentanyl and propofol (Diprivan; Stuart Pharmaceuticals) for induction and a continuous infusion of propofol with 50% nitrous oxide for maintenance of anaesthesia. All patients were premedicated with midazolam, and hypotensive anaesthesia was employed using labetalol. ⋯ The quality of anaesthesia and surgical conditions were good. A rapid, smooth recovery was obtained in 22 patients.
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Randomized Controlled Trial Clinical Trial
Obtunding the sympathetic response to intubation. Experience at 2 minutes after administration of the test agent in patients with cerebral aneurysms.
The sympathetic response to laryngoscopy and intubation was studied in 39 patients who were to undergo surgical clipping of a cerebral aneurysm. Intravascular radial artery pressure and ECG monitoring for ST-segment changes or dysrhythmias were used. Ward blood pressures were controlled on bed rest and labetalol. ⋯ Intubation produced an immediate increase in blood pressure and pulse rate, maximal at 30-60 seconds, falling rapidly towards normal within 2-3 minutes. Alfentanil was very effective in obtunding this response with stable cardiovascular parameters; fentanyl produced a more variable response; and intravenous lignocaine was less satisfactory. Lignocaine spray was ineffective.