Anaesthesia
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Comparative Study
Profound atracurium induced neuromuscular blockade. A comparison of evoked reversal with edrophonium or neostigmine.
Speed of reversal of profound atracurium induced neuromuscular blockade following edrophonium (0.5 or 1.0 mg/kg) or neostigmine (0.04 or 0.08 mg/kg) was measured using the train-of-four pattern of nerve stimulation. In all patients adequate clinical reversal was present when the ratio of the strength of the fourth to the first twitch (T4 ratio) was 0.5. ⋯ However, the larger dose of neostigmine was associated with a reversal time approaching that of edrophonium. Possible explanations for these findings are discussed in terms of contemporary theories of neuromuscular pharmacology.
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We report a case of a young female who developed multiple life threatening complications after a single internal jugular vein catheterisation. They consisted of pleural misplacement of the catheter, massive haemorrhage with cardiovascular collapse following catheter removal, and development of arteriovenous fistula, diagnosed 18 months later.