South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Case Reports
Administration of depolarizing muscle relaxants after non-depolarizer reversal: when is it safe?
In the light of studies on the duration of action and pharmacokinetics of intravenous neostigmine, it is recommended that, depending upon the dosage administered, at least 1 hour should elapse before a depolarizer can safely be given after neuromuscular reversal with neostigmine, and at least 90 - 120 minutes after reversal with physostigmine. It is suggested that a diluted test dose of depolarizer be given first, and its effect monitored with a peripheral nerve stimulator because fasciculations will not occur.
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Randomized Controlled Trial Clinical Trial
Topical analgesia of the upper airway with lignocaine. Absorption and its relationship to toxic and anti-arrhythmic levels.
After routine topical application of lignocaine to the upper airway before passage of an endotracheal tube during general anaesthesia, plasma lignocaine levels were assayed in 20 artificially ventilated and 21 spontaneously ventilating patients. Systemic absorption was found to be rapid but very variable. Mean peak level were attained 15 minutes before spraying and were well below the convulsive threshold for anaesthetized patients, while reputedly anti-arrhythmic levels were achieved by 5 minutes and maintained until 40 minutes. Levels in the ventilated group were significantly higher 20 minutes after administration.
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Uncertainty exists regarding the immunological consequences of vasectomy and the long-term effects of the operation on the hormonal status, genital organs and tract of man. The information available from the literature is summarized. The evidence favours the safety of vasectomy in the human male.
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Ketamine hydrochloride 4 mg in 10 ml 5% dextrose water was administered epidurally to 7 patients suffering from intractable pain in the back, lower abdomen and legs. Pain relief was obtained in all cases. ⋯ No adverse side-effects were noted and no detectable neurological damage resulted. Intraspinal ketamine offers and advantage over the opiates, in that respiratory depression is unlikely to occur.
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Comparative Study Clinical Trial Controlled Clinical Trial
Laminaria tents or vaginal prostaglandins for cervical ripening. A comparative trial.
Laminaria tents and vaginal prostaglandin E2 were used to ripen the cervix in a randomly selected group of 20 patients in whom induction of labour was indicated and the Bishop score was less than 5. In the 14 patients who failed to go into labour both methods improved the Bishop score, but the laminaria tents were significantly (P less than 0,02) more effective cervical dilators. The use of laminaria tents in advocated in selected cases.