Anaesthesia
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The problem of sedating patients requiring prolonged controlled ventilation has recently received considerable attention. Various therapeutic regimes are available and there appears to be a general move away from the use of muscle relaxants towards sedative drugs. ⋯ However, enthusiasm for its use must be tempered by recent reports of cardiovascular collapse following its administration. We wish to report a case of intracranial hypertension following the use of phenoperidine in a ventilated patient with a severe head injury.
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Editorial Historical Article
The fiftieth anniversary of the use of thiopentone in man.
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Case Reports
Intravenous regional analgesia. The danger of the congested arm and the value of occlusion pressure.
Two cases are described in which congestion of the arm occurred during intravenous regional analgesia. One case exhibited signs of serious local anaesthetic toxicity, while a significant plasma bupivacaine level was demonstrated in the other. In a study in a volunteer, leakage of contrast medium past the cuff was demonstrated radiologically only when congestion of the arm was produced. ⋯ Increases in arterial blood pressure occurring during the procedure can also lead to congestion of the arm. Congestion may increase the risk of local anaesthetic agent leaking past the tourniquet into the systemic circulation. Recommendations are made about the choice of cuff gauge pressure and the prevention of arm congestion occurring during intravenous regional analgesia.