Anaesthesia
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The neurological assessment of patients admitted to the intensive care unit after successful resuscitation from cardiopulmonary arrest may be difficult. We describe the cases of two patients who developed myoclonus within 24 hours of hypoxic respiratory and cardiac arrest. Initially, the clonic movements were thought to be generalised convulsions and were treated as such, until it became evident that the patients were aware and distressed. ⋯ Recognition depends on the awareness that the syndrome exists, and is important so that correct therapy can be instituted. There may be important prognostic implications. Both our patients had normal intellectual recovery with moderate residual neurological disability from their movement disorder.
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Five ml diethyl ether was accidentally injected into the epidural space via an epidural catheter at the end of a Caesarean section. Immediately the patient felt a hot and burning pain in her legs that led to paraparesis, with a sensory level to T8. The patient showed bilateral recovery of both motor and sensory functions 4 hours after the accident.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia after triple nerve block for fractured neck of femur.
Fifty patients with fractured neck of femur that required surgical correction with either a compression screw or pin and plate device were randomly allocated to receive one of two anaesthetic techniques, general anaesthesia combined with either opioid supplementation or triple nerve block (three in one block) with subcostal nerve block. The nerve blocks significantly reduced the quantity of opioid administered after operation; 48% of these patients required no additional analgesia in the first 24 hours. Plasma prilocaine levels in these patients were well below the toxic threshold, and peak absorption occurred 20 minutes after the injection. No untoward sequelae were associated with the nerve blocks.