Articles: anesthetics.
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The authors developed a new method of intrathecal local anesthetic injection in rabbits in order to study the relationship between anesthetic concentration and impaired neurologic function. They found that none of the local anesthetics studied produced persistent neurologic damage in concentrations used clinically. ⋯ Pure solutions of relatively insoluble local anesthetics (bupivacaine and 2-chloroprocaine) failed to produce comparable neurologic or neuropathologic changes when tested at concentrations up to their solubility limits. Extensive neurologic impairment was not necessarily accompanied by equally extensive lesions in the spinal cord and nerve roots.
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The effects of the cutaneous application of EMLA cream (a eutectic mixture of lignocaine and prilocaine in their base form) were studied in volunteers. When tested by pin-prick, EMLA cream 2.5% and 5% produced analgesia of the area tested, the cream being most effective if left in contact with the skin for 60 min. ⋯ Tests for delayed hypersensitivity reactions were negative. Plasma concentrations of lignocaine and prilocaine were low after a standard application.
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Case Reports
Guillain-Barré syndrome after epidural anesthesia: direct nerve root damage may trigger disease.
Guillain-Barré syndrome (GBS) appeared in four patients 1 to 2 weeks after epidural anesthesia. In all patients, clinical diagnosis was confirmed by CSF findings and nerve conduction velocity studies. Although epidural anesthesia has not been listed as an antecedent event in GBS, evidence for the relationship has been previously reported. Interaction between the anesthetic agents and peripheral nervous system myelin or local trauma to roots may initiate a cascade of immunologic events that result in the demyelinating neuropathy.
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Acta Anaesthesiol Scand · Aug 1985
Pain on i.v. injection of propofol (ICI 35 868) in emulsion formulation. Short communication.
Pain on injection of three anaesthetic induction agents, thiopentone, methohexitone and propofol (diisopropyl phenol), administered into a vein on the dorsum of the hand or wrist, was studied in 32 premedicated patients undergoing elective surgery. The pain was rated as none, mild or severe. ⋯ The pain was rated as severe more often in patients receiving propofol (67%, P less than 0.01 vs thiopentone) than in those anaesthetized with methohexitone (20%) or thiopentone (0%). It is concluded that the fat emulsion form of propofol, when injected into a peripheral vein, frequently induces severe pain.