British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Non-selective and cyclo-oxygenase-2-specific non-steroidal anti-inflammatory drugs impair the hyperaemic response of skin to brief axillary artery occlusion.
Cyclo-oxygenase-2 (COX-2)-specific inhibitors are marketed as safer analgesics than non-selective non-steroidal anti-inflammatory drugs. However, there has been conflicting evidence concerning endothelial function and cardiovascular risk after COX-2 inhibitor use. We investigated forearm skin vascular reactivity to brief axillary artery occlusion in healthy volunteers after a single dose of the non-steroidal anti-inflammatory drugs ibuprofen (non-selective) and rofecoxib (COX-2 specific). ⋯ Both COX-2 and non-selective non-steroidal anti-inflammatory drugs, when given to healthy volunteers as single therapeutic doses, decrease skin microvascular tone but do not impair maximal vasodilatory ability.
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A 67-yr-old man weighing 104 kg, with a history of hypertension, underwent laparoscopic cholecystectomy. His preoperative serum potassium was 3.4 mmol litre(-1). The patient received cisatracurium 14 mg, which was antagonized with neostigmine 2.5 mg and glycoprolate 0.5 mg at the end of the procedure. ⋯ Administration of magnesium appears to have caused recurarization in this patient. The dose of magnesium alone would not be expected to cause muscle weakness. Potentiation of neuromuscular blocking drugs by magnesium is well recognized, and we recommend its use is avoided for at least 30 min after reversal of neuromuscular block.
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There is good evidence to support the use of a "protective" ventilation strategy, using small tidal volumes and inspiratory pressures, in patients with acute respiratory distress syndrome. Many general intensive care units in the UK are being slow to adopt this approach and we therefore set out to devise a method to audit ventilation and possibly influence practice in these units. ⋯ To assist progress towards the use of a "protective" ventilation strategy in intensive care units in the UK, we devised a simple, robust audit method. We have shown how this method can give a more uniform practice of ventilation in critical care units, with the introduction of nurse-run protocols.
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Haemophilia A is a bleeding disorder that has a spectrum of manifestations ranging from persistent bleeding after minor trauma to spontaneous haemorrhage. As an X-linked disease, it has a rare occurrence in females. We report a case of a pregnant patient with severe haemophilia A, who received epidural analgesia during labour. The prepartum, intrapartum and postpartum care of a patient with such a bleeding diathesis is discussed.