British journal of anaesthesia
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The electrocardiograph (ECG) was recorded continuously in 20 children undergoing adenoidectomy during halothane anaesthesia. Five surface ECG leads and an oesophageal lead were used. In 11 children, there were QRS complexes which had a shape distinctly different from that of the ordinary sinus-evoked beats. ⋯ Although the anomalous QRS complexes were premature, P waves and P-P intervals were unchanged. In some children, there appeared to be ventricular capture beats and fusion beats. Because of this, and in view of evidence gathered from studies in animals, by other authors, we considered it likely that the anomalous beats were ventricular in origin.
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The rationale, anatomy and technique of transsacral phenol injection are described and the author's results in the treatment of nine patients with intractable perineal pain presented. The technique is recommended as a safe, simple and useful alternative to intrathecal neurolysis in this condition.
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This survey compared the safety of 261 healthy mothers of whom 170 received extradural and 91 general anaesthesia for Caesarean section. Anaesthetics were conducted in routine hospital practice by six anaesthetic registrars. ⋯ Hypotension occurred in 11 patients, inadequacy of analgesia in 25 patients and a period of unawareness in 16 patients following sedation after delivery. Extradural block for Caesarean section is thus seen as safer than general anaesthesia when performed by the same group of anaesthetic trainees on healthy mothers.
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The neuromuscular and cardiac vagus blocking actions of pancuronium, vecuronium (Org NC45) and their respective potential hydroxy metabolites have been studied in the chloralose-anaesthetized cat. Pancuronium was three times more potent as a neuromuscular blocker than its 3-hydroxy derivative, 20 times more potent than the 17-hydroxy derivative and 45 times more potent than the 3,17-dihydroxy derivative. The vagal:neuromuscular block ratios measured at 50% inhibition for these compounds were pancuronium 3.0, 3-hydroxy derivative 6.4, 17-hydroxy derivative 1.1 and 3,17-dihydroxy derivative 0.36 (a value greater than unity indicated greater potency at the neuromuscular junction). ⋯ In addition, the time-course of its action was not different from that of vecuronium. Thus, it is concluded that this potential metabolite is unlikely to give rise to tachycardia in man. It is unlikely that the 17-hydroxy and 3,17-dihydroxy derivatives of vecuronium would be produced in sufficiently great quantities by metabolism from vecuronium to result in either tachycardia or residual neuromuscular blockade.