Anaesthesia
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The lumbar epidural space of 14 autopsy subjects was examined by epiduroscopy. The aim was to compare the midline and paramedian approaches of locating the space, the estimated risk of accidental dural puncture, the course taken by the epidural catheter after introduction and with special attention to the influence of the dorsomedian connective tissue band. The paramedian needle passed a greater distance within the epidural space before contact with the dura mater and demonstrated a low risk of accidental dural puncture. ⋯ The midline catheter caused tenting of the dura in all 14 cases and the direction of travel was variable. Differences were statistically significant. Influence of the dorsomedian connective tissue band was greatest on the behaviour of the midline needle and catheter.
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We report a case of massive, fatal, systemic gas embolism which occurred during the course of laser bronchoscopic resection of a bronchial carcinoma. The clinical features of systemic air embolism are discussed.
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The pressures used in vivo to administer epidural doses of local anaesthetic were recorded for 16- and 18-gauge multihole catheters. Observations were made on 10 patients in labour for each catheter gauge. ⋯ For each size of catheter, with increasing pressure, flow appeared at the proximal, then the middle, and finally the distal hole. This emphasises that the effect of epidural doses can vary depending on the pressure of injection, especially if the catheter had been passed partially through the dura.
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Comparative Study
The control of post-thoracotomy pain. A comparative evaluation of thoracic epidural fentanyl infusions and cryo-analgesia.
This is a comparative study of two methods to relieve postoperative thoracotomy pain. Continuous thoracic epidural infusion of fentanyl produced superior analgesia when compared with cryo-analgesia of the relevant thoracic nerves. ⋯ This difference was significant at p less than 0.001. Respiratory and cardiovascular measurements were similar in both groups and the only side effect attributable to the epidural fentanyl was itching but this was not a problem.