Anaesthesia
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Randomized Controlled Trial Clinical Trial
A comparison of diclofenac and ketorolac for postoperative analgesia following day-case arthroscopy of the knee joint.
Seventy-one patients presenting for day-case arthroscopy were randomly allocated to receive either intramuscular diclofenac 75 mg or ketorolac 30 mg immediately after induction of anaesthesia. One hour after operation visual analogue pain scores were significantly lower in the ketorolac group compared with those receiving diclofenac. ⋯ Discomfort in the operated knee was similar for both groups on the day following surgery, but pain from the intramuscular injection site was significantly greater in the diclofenac group. Intramuscular ketorolac 30 mg provided better postoperative analgesia and less pain at the injection site than diclofenac 75 mg.
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Case Reports Comparative Study
Vecuronium block in the myasthenic patient. Influence of anticholinesterase therapy.
The neuromuscular block of vecuronium was investigated in two myasthenic patients undergoing thymectomy. The first patient had no pre-operative anticholinesterase therapy, the second patient was given pyridostigmine 60 mg 4 hourly, continued until the morning of surgery. In the two patients, neuromuscular block of vecuronium was monitored by electromyography. The results suggest that the neuromuscular block of vecuronium may be decreased by pre-operative preparation of the myasthenic patient by pyridostigmine.
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Comparative Study
Orotracheal intubation in patients with potential cervical spine injuries. An indication for the gum elastic bougie.
The conditions for emergency tracheal intubation of patients with cervical spine injury were simulated in 157 patients during induction of anaesthesia for routine surgery. The view of the larynx obtained during laryngoscopy with the head in the optimum intubating position was compared with that obtained when manual in-line stabilisation of the cervical spine and cricoid pressure were used. During laryngoscopy with cervical stabilisation, the view of the larynx was reduced in 45% of patients, and in 22% of patients nothing was visible beyond the epiglottis. ⋯ In addition, five patients in this group could not be directly intubated. Using the gum elastic bougie all patients, including the failures from the visual group, were intubated within 45 s (median 25 s). We recommend the gum elastic bougie as an aid to intubating the patient with suspected cervical spine injury, particularly when the glottis is not immediately visible.
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Comment Letter Case Reports
Unexpectedly high spinal anaesthesia following failed extradural anaesthesia for caesarean section.
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Anaesthetists require a good knowledge of the excretion of drugs in breast milk and the potential hazards to suckling infants of drug ingestion via breast milk. A brief account of the physiology of lactation is given. The mechanisms of drug passage into breast milk are discussed followed by a review of the excretion in breast milk of drugs used in anaesthetic practice. Suggestions for the management of anaesthesia in breast feeding mothers are offered.