Anaesthesia
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The effect of neostigmine on neuromuscular function was examined after spontaneous recovery from an atracurium-induced neuromuscular blockade, which reached a train-of-four ratio of either 0.5 or 0.9. Two doses of neostigmine 2.5 mg were given 5 minutes apart. Neuromuscular recovery was assessed with train-of-four and tetanic stimuli. ⋯ The train-of-four measured mechanically was adversely affected to a small degree, but when measured with the electromyograph no significant change occurred. Neostigmine may adversely affect neuromuscular function after spontaneous recovery from a non-depolarising block. This is unlikely with a single modest dose and any effects are probably short-lived.
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Six patients were referred to our hospital with spinal arachnoiditis after epidural anaesthesia performed one month to 3 years before the onset of symptoms. None had had previous lumbar surgery or trauma, intraspinal haemorrhage, infections or other known causative factors of arachnoiditis. All the patients were free of neurological symptoms before epidural anaesthesia and only two had transient distress in the period immediately following the procedure. ⋯ Three patients were confined to a wheelchair after 3 years of follow-up. To our knowledge, the anaesthetic procedures were performed according to standard methods. Arachnoiditis seems to be due to the epidural injection of foreign substances, and may be related to anaesthetic-vasoconstrictor solution or contaminants.
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Case Reports
Termination of paroxysmal supraventricular tachycardia by intravenous adenosine in a child.
A fit 6-year-old child developed paroxysmal supraventricular tachycardia at the end of an operation for adenotonsillectomy. Sinus rhythm was rapidly restored with intravenous adenosine.