British journal of anaesthesia
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A retrospective study of serious non-fatal complications of extradural block in obstetric practice was carried out using a postal questionnaire. Two hundred and three obstetric units in the United Kingdom (responsible for 2,580,000 deliveries from 1982 to 1986 inclusive) responded. A total of 505,000 extradural blocks were performed, 84% for relief of pain in labour and 16% for Caesarean section. ⋯ Neuropathy involving a single spinal nerve, acute toxicity from the local anaesthetic, and problems associated with accidental dural puncture were the commonest complications. This investigation indicates the need for a prospective study. Although rare, serious complications could be reduced further by meticulous technique, while early diagnosis and treatment of untoward events would reduce the incidence of permanent disability.
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A retrospective study was carried out to determine analgesic requirements in a group of orthopaedic outpatients (n = 145) and oral surgery inpatients (n = 172). The orthopaedic patients received a codeine-paracetamol premedication, an opioid during operation, or no analgesic. ⋯ In the patients undergoing oral surgery, ibuprofen administered before operation significantly reduced analgesic requirement, without unwanted side effects. The use of codeine-paracetamol or a non-steroidal anti-inflammatory agent before body surface surgery appeared to be advantageous in reducing postoperative analgesic needs, without causing problems associated with the stronger opioids.
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We have studied the effect of i.v. midazolam on median nerve somatosensory evoked potentials (SSEP) in 10 unpremedicated adults. Anaesthesia was induced with midazolam by bolus administration (0.2 mg kg-1) followed by infusion (5 mg h-1). The latency and amplitudes of the SSEP responses over the second cervical vertebrae (SC2) and sensory cortex (P17, N20, P25) were recorded before and for 10 min after induction. ⋯ Small but statistically significant increases in latency of the cortical N20 (P less than 0.005) and P25 (P less than 0.001) waves and interwave conduction times of SC2 to P25 (P less than 0.005) and N20 to P25 (P less than 0.021) were observed. Cortical amplitude (N20-P25) decreased significantly (P less than 0.012), to approximately 60% of baseline. These results demonstrated that midazolam produced a depression of cortical SSEP amplitude without clinically significant alterations in latency.