South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Portal-systemic shunts, either spontaneous or artificial, are occasionally complicated by the development of spastic paraparesis. We report on 2 young patients who developed this complication following splenorenal shunts which were made for the treatment of oesophageal varices associated with cirrhosis of the liver and portal hypertension.
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Case Reports
Administration of depolarizing muscle relaxants after non-depolarizer reversal: when is it safe?
In the light of studies on the duration of action and pharmacokinetics of intravenous neostigmine, it is recommended that, depending upon the dosage administered, at least 1 hour should elapse before a depolarizer can safely be given after neuromuscular reversal with neostigmine, and at least 90 - 120 minutes after reversal with physostigmine. It is suggested that a diluted test dose of depolarizer be given first, and its effect monitored with a peripheral nerve stimulator because fasciculations will not occur.
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Randomized Controlled Trial Clinical Trial
Topical analgesia of the upper airway with lignocaine. Absorption and its relationship to toxic and anti-arrhythmic levels.
After routine topical application of lignocaine to the upper airway before passage of an endotracheal tube during general anaesthesia, plasma lignocaine levels were assayed in 20 artificially ventilated and 21 spontaneously ventilating patients. Systemic absorption was found to be rapid but very variable. Mean peak level were attained 15 minutes before spraying and were well below the convulsive threshold for anaesthetized patients, while reputedly anti-arrhythmic levels were achieved by 5 minutes and maintained until 40 minutes. Levels in the ventilated group were significantly higher 20 minutes after administration.