British journal of anaesthesia
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Ilio-inguinal nerve block is commonly used in children to provide analgesia after surgery in the groin. Several case reports and clinical studies have described leg weakness after this technique and suggest that it may caused by inadvertent femoral nerve block. No prospective studies describing the incidence of this complication have been published. ⋯ Leg weakness consistent with a femoral nerve block occurs after ilio-inguinal nerve block in approximately one in nine children.
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We describe the locked-in syndrome in a 31-yr-old patient after right upper lobectomy for suspected metastasis. After surgery, vertical eye movement was her only means of communication. ⋯ Post-mortem examination showed extensive metastatic tumour deposition in the ventral pons. We discuss the clinical features of this syndrome and factors that may affect onset, diagnosis and management.
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The coronavirus which causes severe acute respiratory syndrome (SARS) is a virulent and highly contagious organism. Of the 1755 SARS patients in Hong Kong, over 400 were healthcare workers. ⋯ These points are especially pertinent when anaesthetizing SARS patients for high-risk procedures such as tracheostomy. We describe the management of such a case.
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Case Reports
Acute motor axonal polyneuropathy after a cisatracurium infusion and concomitant corticosteroid therapy.
A 40-yr-old male was admitted to the intensive care unit following blunt chest trauma. He had multiple rib fractures, bilateral pneumothoraces, and acute respiratory failure requiring mechanical ventilation. Sedation was achieved with midazolam and morphine, and later with propofol. ⋯ No sensory deficits were observed. Electromyography (EMG), repetitive nerve stimulation testing, and single fibre EMG (SFEMG) were performed at regular intervals after stopping cisatracurium. Clinical symptoms and electrophysiological examinations supported the diagnosis of acute motor axonal polyneuropathy related to concomitant administration of cisatracurium and corticosteroid therapy.
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The minimum alveolar concentration (MAC) of an inhaled anaesthetic describes its potency as a general anaesthetic. Individuals vary in their sensitivity to anaesthetics and we sought to determine whether an individual animal's sensitivity to inhaled anaesthetics would be maintained across different agents. ⋯ These findings show that an individual has a consistent degree of sensitivity to a variety of inhaled anaesthetics, suggesting a genetic basis for sensitivity to inhaled anaesthetic effects.