Articles: anesthetics.
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The effects of the cutaneous application of EMLA cream (a eutectic mixture of lignocaine and prilocaine in their base form) were studied in volunteers. When tested by pin-prick, EMLA cream 2.5% and 5% produced analgesia of the area tested, the cream being most effective if left in contact with the skin for 60 min. ⋯ Tests for delayed hypersensitivity reactions were negative. Plasma concentrations of lignocaine and prilocaine were low after a standard application.
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The authors developed a new method of intrathecal local anesthetic injection in rabbits in order to study the relationship between anesthetic concentration and impaired neurologic function. They found that none of the local anesthetics studied produced persistent neurologic damage in concentrations used clinically. ⋯ Pure solutions of relatively insoluble local anesthetics (bupivacaine and 2-chloroprocaine) failed to produce comparable neurologic or neuropathologic changes when tested at concentrations up to their solubility limits. Extensive neurologic impairment was not necessarily accompanied by equally extensive lesions in the spinal cord and nerve roots.
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Case Reports
Guillain-Barré syndrome after epidural anesthesia: direct nerve root damage may trigger disease.
Guillain-Barré syndrome (GBS) appeared in four patients 1 to 2 weeks after epidural anesthesia. In all patients, clinical diagnosis was confirmed by CSF findings and nerve conduction velocity studies. Although epidural anesthesia has not been listed as an antecedent event in GBS, evidence for the relationship has been previously reported. Interaction between the anesthetic agents and peripheral nervous system myelin or local trauma to roots may initiate a cascade of immunologic events that result in the demyelinating neuropathy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ICI 35868, etomidate and methohexitone for day-case anaesthesia.
The anaesthetic properties and side-effects of propofol 1.5 mg kg-1, etomidate 0.2 mg kg-1, and methohexitone 1.5 mg kg-1 were compared in 71 healthy female patients undergoing short gynaecological procedures. Propofol proved to be a safe and effective agent for induction and maintenance of anaesthesia and was associated with a lower incidence of side-effects than either etomidate or methohexitone.