Anaesthesia
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Comparative Study
Postdural puncture headache. A comparison between 26- and 29-gauge needles in young patients.
The incidence of postdural puncture headache after spinal anaesthesia with two types of 26- and 29-gauge needles was investigated in 149 patients less than 30 years old. Ten patients, (6.7%), six men and four women, developed typical symptoms of postdural puncture headache, while six (4.0%) developed headache of other origin. ⋯ Spinal anaesthesia in four patients (8%) was impossible to perform with the 29-gauge needle. By using the latter, spinal anaesthesia can be given to young adults with little risk of postdural puncture headache.
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The successful management of a patient with Eisenmenger's syndrome undergoing bilateral herniorrhaphy is described, and some of the anaesthetic problems associated with this condition are considered. The case is reported because epidural anaesthesia is performed rarely in these patients. The use of subcutaneous heparin, the level of monitoring required, and the value of pulse oximetry are also discussed.
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Patients who underwent peripheral arterial surgery had anaesthesia maintained with an infusion of midazolam. They were allowed either to recover spontaneously or to have the effects of midazolam reversed by flumazenil at the end of surgery. This study demonstrated that the cardiovascular responses to arousal using flumazenil are no different from those seen when the patient is allowed to recover in the normal way. This result has obvious advantages for clinical practice but the dangers of resedation must not be forgotten.