Anaesthesia
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Case Reports
Respiratory depression after intrathecal opioids. Report of a patient receiving long-term epidural opioid therapy.
Morphine 20 mg and pethidine 50 mg were accidentally injected intrathecally in a patient who had received large doses of opioids epidurally for cancer pain and who had shown tolerance to their effects. The well established tolerance to spinal opioids did not protect the patient against a moderate degree of respiratory depression. Morphine concentrations 6.5 hours after the morphine injection were 103,500 ng/ml and 52 ng/ml in cerebrospinal fluid and serum, respectively.
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Randomized Controlled Trial Clinical Trial
Postoperative headache in young patients after spinal anaesthesia.
Spinal anaesthesia was performed on 247 young adult patients with a 25-G needle. Rectal administration of indomethacin had no significant effect on the incidence of postdural puncture headache, which occurred in 16.8% of patients who received the drug compared to 24.5% who received a placebo. A history of headache pre-operatively did not influence the incidence of postlumbar puncture headache.
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A 67-year-old woman suffered cardiovascular collapse during induction of anaesthesia. This was later shown to be anaphylactic in origin; the causative agent was alcuronium. ⋯ Future anaesthesia with decreased risk was thereby assured. The clinical nature of this reaction and a review of the literature implicate the cardiovascular system as the principal target in this type of reaction to alcuronium and suggest that the heart is directly involved.
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Randomized Controlled Trial Comparative Study Clinical Trial
Quality of axillary brachial plexus block. Comparison of success rate using perivascular and nerve stimulator techniques.
A perivascular catheter technique (PVT) and a nerve stimulator technique (NST) for axillary brachial plexus block were compared in terms of quality: complete, incomplete or failed blocks. In a randomised series, 30 PVT blocks and 30 NST blocks were performed by three staff anaesthetists. ⋯ In both groups eight patients needed supplementation with additional conduction blocks of 1-3 peripheral nerves. It is concluded that a nerve stimulator technique may increase the success rate of axillary brachial plexus block to some extent.