Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Letter Case Reports
Postoperative recurrent paralysis in an infant after mivacurium infusion.
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During the past decade, major advances have taken place with regard to intravenous infusion anaesthesia. New opioid analgesics, iv anaesthetics, and muscle relaxants have become available, which are characterized by a rapid onset of action, short duration of clinical effect, and favourable side effect profiles. Optimal administration of these drugs is often best achieved by continuous infusion, rather than a more traditional technique of intermittent bolus administration. ⋯ Pharmacokinetic principles guide rational selection of the iv anaesthetic drugs according to both procedure and patient-specific requirements. In addition, improvements in the new programmable syringe infusion pumps provide a degree of simplicity and accuracy in operation, which make iv infusion of one, two or three components of the anaesthetic state a simple and practical reality for most procedures. In this CME article, these issues will be reviewed according to the following outline: Historical considerations; Rationale for continuous infusion of iv anaesthetic drugs; Pharmacokinetic and pharmacodynamic considerations; Infusion schemes; New techniques, new indications; IV anaesthetic delivery systems; Pharmacoeconomic considerations; Conclusions.
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The purpose of this report is to describe a new complication of epidural blood patch for inadvertent dural puncture. A dural tap in an obstetric patient was managed initially with a prophylactic blood patch via the epidural catheter. Despite this, 48 hr later, she developed post-dural puncture headache, neck, and shoulder pain, and was given a second epidural blood patch. ⋯ There were no further sequelae. Although severe complications of epidural blood patch are rare, they are alarming. Exacerbation of the original symptoms of post-dural puncture headache caused by, or following, epidural blood patching has not previously been reported.