British journal of anaesthesia
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A 19-yr-old woman developed a paraplegia with a T10 sensory level at 22 weeks' gestation. The spinal injury was caused by spontaneous bleed of a presumed arteriovenous malformation in the spinal cord. She presented for Caesarean section at term because of the breech position of her fetus. The successful use of a combined spinal epidural-regional anaesthetic is described and the risks of general and regional anaesthesia are discussed.
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The evoked electromyogram often decreases during anaesthesia in the absence of neuromuscular block. We have measured the electromyogram of the first dorsal interosseous muscle evoked by train-of-four stimulation of the ulnar nerve in 63 patients undergoing anaesthesia for minor surgery. We used Medicotest P-00-S electrodes, a Datex Relaxograph and a current sink in the stimulating leads in parallel with the current path through the patient. ⋯ In the remaining 50 patients, the response decreased to 78.4% (SD 27.1%, range 7.5-95.0%) of baseline values over the first 20 min of anaesthesia. In 22 of these patients, the electromyographic response increased from 71.4 (SD 22.6)% to 92.3 (9.5)% of baseline responses when the stimulus current was increased by 12.3 (2.4) mA, while in the remaining 28 patients the response decreased to 83.7 (10.6)% and did not increase with increasing stimulus current. These results suggest that loss of supramaximal stimulation is partly responsible for the observed changes in the evoked electromyogram during anaesthesia.
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It is known that volatile anaesthetics protect myocardial tissue against ischaemic and reperfusion injury in vitro. In this investigation, we have determined the effects of the inhalation anaesthetics, enflurane, isoflurane, sevoflurane and desflurane, administered only during early reperfusion, on myocardial reperfusion injury in vivo. Fifty chloralose-anaesthetized rabbits were subjected to 30 min of occlusion of a major coronary artery followed by 120 min of reperfusion. ⋯ The results show that desflurane and sevoflurane markedly reduced infarct size and therefore can protect myocardium against reperfusion injury in vivo. Enflurane had only a marginal effect and isoflurane offered no protection against reperfusion injury in vivo. These different effects suggest different protective mechanisms at the cellular level.