Anaesthesia
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As anaesthetists have become more aware of malignant hyperthermia the mortality rate has fallen, but concommitantly the number of dubious and aborted cases has increased. All probands who developed a suspected malignant hyperthermia reaction during anaesthesia and subsequently underwent muscle biopsy were classified according to the clinical presentation. ⋯ Certain clinical features were found to be of more value as predictors than others; these included a high creative kinase and myoglobinuria. The accuracy of prediction depends on a clear contemporaneous description of the clinical events.
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A patient with grossly deformed vertebral anatomy, scheduled for elective Caesarean section, expressed her wish to stay fully awake during the procedure. Epidural anaesthesia was considered to be impracticable, while dural puncture appeared possible only at thoracic level. Spinal anaesthesia using a subarachnoid catheter placed at T7-8 was employed successfully.
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A caudal epidural catheter was inserted in 20 premature, high risk infants for abdominal or thoracic surgery under combined caudal epidural and general anaesthesia. Epidurography was used to confirm the position of the catheter which was found to be misplaced in three patients. The catheter penetrated the dura in one case, in another the tip was located in an epidural vessel and in the third the catheter was seen to be curled up within the epidural space. It was concluded that epidurographic control is essential with this method of anaesthesia in very small infants, in whom it was found to provide considerable advantages despite serious risks.