British journal of anaesthesia
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Anaphylaxis during anaesthesia is a rare event that in ∼60-70% of cases is secondary to neuromuscular blocking agents. It has been suggested previously that the recent introduction of sugammadex may provide a novel therapeutic approach to the management of rocuronium-induced anaphylaxis. ⋯ This was associated with an improvement in the adverse haemodynamic state. The underlying reasons for this are unclear, but sugammadex may potentially be a useful adjunct in the management of rocuronium-induced anaphylaxis.
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Degenerative processes of the lumbar spine may change the position of the sympathetic trunk which might cause failure of sympathetic blocks owing to inadequate distribution of local anaesthetic. ⋯ Spondylophytes influenced the location of the LST and the distribution of the local anaesthetic. The local anaesthetic should wash around the spondylophyte to reach all possible locations of the chain. The medial margin of the psoas muscle was confirmed to be a consistent reference point at intervertebral disc level L2/3.
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Randomized Controlled Trial
Intubating conditions and adverse events during sevoflurane induction in infants.
The aim of this study was to compare intubating conditions and adverse events after sevoflurane induction in infants, with or without the use of rocuronium or alfentanil. ⋯ In 1- to 24-month-old infants, the addition of 0.3 mg kg⁻¹ rocuronium to 8% sevoflurane improved intubating conditions and decreased the frequency of respiratory adverse events. Alfentanil provided no additional benefit in this study.
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Randomized Controlled Trial
Patient-initiated mandatory boluses for ambulatory continuous interscalene analgesia: an effective strategy for optimizing analgesia and minimizing side-effects.
This prospective, randomized study tested the hypothesis that a reduced dose continuous interscalene regimen incorporating a low background infusion with mandatory boluses would provide similar shoulder surgery analgesia compared with a dose regimen incorporating a conventional higher background infusion. ⋯ Continuous interscalene ropivacaine 0.2% 2 ml h⁻¹ with mandatory 6 hourly (and PRN) boluses provides similar analgesia after rotator cuff repair but with reduced side-effects compared with 5 ml h⁻¹ with PRN only boluses.
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Paravertebral regional anaesthesia is used to treat pain after several surgical procedures. This study aimed to improve on our first published ultrasound-guided approach to the paravertebral space (PVS) and to investigate a possible discrepancy between the needle, catheter, and contrast dye position. ⋯ Our new PUSG technique has a high success rate for paravertebral needle placement. Although needles were correctly positioned, catheters were usually found distant from the needle-tip position.