British journal of anaesthesia
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We describe the anaesthetic management of a pair of thoracopagus twins of 14 months of age undergoing complex cardiac evaluation. Synchronous ventilation of the twins, needed for the ECG-gated magnetic resonance imaging-angiography, was achieved through a Carlens (Y) adaptor during procedures and transport. The complex logistical implications are obvious. We also describe the first use of bispectral index monitor for detection of cross-circulation in conjoint twins.
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Case Reports
Repetitive paravertebral nerve block using a catheter technique for pain relief in post-herpetic neuralgia.
We described in this report a case of post-herpetic neuralgia refractory to medical therapy that was successfully treated with repetitive injections of local aesthetic mixture (bupivacaine 0.5% 19 ml and clonidine 150 microg ml(-1) 1 ml) every 48 h for 3 weeks using a paravertebral catheter inserted at T2-T3 level.
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During general anaesthesia in the presence of neuromuscular blocking drugs clinical criteria cannot detect the presence of consciousness. Various 'depth of anaesthesia' monitors are available which claim to prevent consciousness and/or reduce anaesthetic drug use. This study uses the Narcotrend anaesthesia brain monitor to guide anaesthetic administration but at the same time checks for the presence of intra-operative consciousness by using the 'isolated forearm' technique throughout the whole surgical/anaesthetic procedure. ⋯ The Narcotrend was unable to differentiate reliably between conscious and unconscious patients during general anaesthesia when neuromuscular blocking agents were used.
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Randomized Controlled Trial Comparative Study
Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study.
Bladder discomfort related to intraoperative catheterization of urinary bladder is a distressing symptom and more so in patients awakening from anaesthesia. These symptoms are similar to symptoms of overactive bladder. Muscarinic receptor antagonists have been reported to be effective in the treatment of overactive bladder. This study was therefore undertaken to evaluate the efficacy of oxybutynin and tolterodine in preventing catheter related bladder discomfort. ⋯ Pretreatment with either oxybutynin or tolterodine reduces the incidence and severity of catheter related bladder discomfort.