Anaesthesia
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A severe case of drug-induced toxic epidermal necrolysis is described in which the adult respiratory distress syndrome developed, requiring a prolonged period of mechanical ventilation and intensive care. The importance of early transfer to the intensive care unit for monitoring and prompt treatment of complications of this rare condition is emphasised.
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Multicenter Study Clinical Trial
Paravertebral blockade. Failure rate and complications.
The failure rate and complications were studied prospectively in 367 paediatric and adult patients who had received a thoracic or lumbar paravertebral block. The overall failure rate was 10.1%; adults 10.7%; children 6.2%. The frequency of complications were: hypotension: 4.6%; vascular puncture: 3.8%; pleural puncture: 1.1%; pneumothorax: 0.5%. Since these results are similar to those found with alternative methods, e.g. epidural, intrapleural and intercostal blocks, paravertebral block can be recommended as an effective, safe technique for unilateral analgesia in both adults and children.
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Randomized Controlled Trial Clinical Trial
The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children.
Both caudal anaesthesia and non-steroidal anti-inflammatory drugs have been used in the management of postoperative pain in children. The aim of the present study was to evaluate the combination of caudal analgesia and rectally administered diclofenac in the treatment of pain following minor surgery in children. ⋯ Children given a caudal block alone were more likely to need analgesia in the first 24 h postoperatively. It would appear that the combination of a caudal block and rectal diclofenac in children undergoing minor lower abdominal surgery reduces the need for subsequent analgesia.
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Clinical Trial Controlled Clinical Trial
Correct positioning of the epiglottis for application of the Brain laryngeal mask airway.
Positioning of the epiglottis when the Brain laryngeal mask airway is in place was studied in 20 adult patients, using a new technique of insertion. The laryngeal mask was inserted when the anterior displacement of the mandible extended the epiglottis, thereby the providing an excellent airway in all patients. In 10 out of these 20 patients, the conventional technique of insertion revealed an incomplete extension of the epiglottis, and inadequate opening of the laryngeal inlet. It was concluded that the anterior displacement of the mandible during insertion of the laryngeal mask enhances the opening of the larynx, the result being an excellent airway.