Anaesthesia
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Plasma bupivacaine concentrations were measured in 27 children aged 3-7 years who received one of two analgesic regimens for herniotomy or orchidopexy. Analgesia was provided either by caudal epidural bupivacaine 0.2% 2 mg/kg (n = 14) or by ilioinguinal-iliohypogastric nerve block with bupivacaine 0.5% 1.25 mg/kg (n = 13). ⋯ Time to peak plasma concentrations were 29.6 (7.9) and 22.3 (10.9) minutes respectively. These concentrations are well below the potentially toxic level of 4.0 micrograms/ml, but suggest that uptake of bupivacaine is more rapid after ilioinguinal-iliohypogastric nerve block than during caudal analgesia.
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This survey reviews the structure and content of all anaesthetic record charts in use in the 40 hospitals of the Yorkshire Regional Health Authority in the light of previous recommendations. Twenty-two different anaesthetic charts were used by 290 anaesthetists in this region. ⋯ Fourteen of the 22 charts omitted important headings concerned with patient identification and eight charts did not provide a record of the whole perioperative period. Some comprehensive forms are in use, chiefly in smaller hospitals, but there have been few changes in design in the last 10 years despite increasing medicolegal awareness.
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A case is described of an extensive block and hypotension which occurred after inadvertent dural puncture and subsequent epidural injection of bupivacaine. The subarachnoid spread of solution from the extradural space was confirmed radiologically.
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A patient is described who has received nine anaesthetics, the last three since he was confirmed as susceptible to malignant hyperthermia. The ninth anaesthetic illustrates the prophylactic therapy and management in detail. Certain aspects of the problem are discussed.
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An experimental study of the Oxford Miniature Vaporizer in combination with a paediatric resuscitation bag has demonstrated efficient halothane vaporization at small tidal volumes. This technique will be appropriate in paediatric anaesthesia with the Triservice apparatus.