British journal of anaesthesia
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Comparative Study
Subarachnoid blockade with bupivacaine. A comparison with cinchocaine.
Subarachnoid anaesthesia was induced in 40 patients with 0.5% bupivacaine 3 ml with no glucose, 5% glucose or 8% glucose, or with hyperbaric cinchocaine. The injections were made in the lateral position and the patients turned supine immediately. The onset, extent and duration of sensory and motor blockade, the quality of anaesthesia, cardiovascular effects, and the frequency of side-effects were studied. ⋯ Cinchocaine produced a longer duration of action at T10 and T12 than the hyperbaric bupivacaine solutions. No advantage was seen when 8% rather than 5% glucose was used. The glucose-free bupivacaine produced intense blockade of long duration and was suitable when a lower level of blockade was adequate for the proposed surgery.
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India ink was injected through extradural catheters placed in the posterior intercostal space in 12 cadavers undergoing autopsy and the subsequent spread of the India ink was assessed under direct vision. The ink spread subpleurally to reach a number of intercostal spaces and medially to reach the paravertebral space. It is concluded that analgesia extending over a number of dermatomes is achieved by subpleural tracking of local anaesthetic to reach intercostal nerves above and below the one injected.
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Case Reports
"Failed intubation" in obstetric anaesthesia. An indication for use of the "Esophageal Gastric Tube Airway".
The management of failure to intubate the trachea during emergency Caesarean section in a 116.7-kg woman is described. General anaesthesia was continued with the aid of a Gordon and Don Michael Esophageal Gastric Tube Airway. The forward displacement of the larynx caused by the tube in the oesophagus improved the patency of the airway.
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Studies with an emulsion formulation of ICI 35 868 (2,6- diisopropylphenol ) indicate that this new formulation has anaesthetic properties in rats and mice, and haemodynamic effects in the mini-pig which are similar to those of the previously available Cremophor formulation. Administration of the emulsion formulation to dogs produced no untoward effect, whereas the Cremophor formulation produced a marked increase in plasma histamine concentration. In the mini-pig, no adverse response was produced by the repeated administration of the emulsion formulation of ICI 35 868, whereas the Cremophor formulation produced anaphylactoid responses when a second injection was given 1 week after an uneventful first exposure to this formulation. Behavioural responses in the rat suggest that the emulsion formulation may produce less discomfort on i.v. injection.
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Letter Case Reports
Atracurium v. suxamethonium in a case of organophosphorous poisoning.