Migration of interscalene catheter--not proven.
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Biomedical subjects
Publications and source records attributed to W Harrop-Griffiths.
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A patient who was suffering an exacerbation of myasthenia gravis dislocated her elbow. She underwent closed reduction of the dislocation under vertical infraclavicular brachial plexus blockade. The technique was successful but was associated with a 29% decrease in forced vital capacity, from 1.7 l to 1.2 l. The patient did not show any symptoms of ventilatory failure. Her recovery was uncomplicated.
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In order to compare the anaesthetic staffing and facilities provided for patients undergoing electroconvulsive therapy with those provided for patients undergoing elective cystoscopy, a confidential telephone enquiry was conducted. An anaesthetist in each of the 40 hospitals where electroconvulsive therapy is performed in three Health Regions chosen at random was questioned. The results show that a high standard of care is provided for patients undergoing elective cystoscopy in terms of pre-operative assessment, anaesthetic assistance, intra-operative monitoring and postoperative recovery facilities. The standards of care and of facilities for patients undergoing electroconvulsive therapy are substantially inferior and commonly fall short of accepted national guidelines.
The anaesthetic management of a patient with an unsuspected homozygous atypical pseudocholinesterase genotype is described. Suxamethonium was administered after an arterial tourniquet had been applied to the patient's right leg. After release of the tourniquet and termination of the anaesthetic it was noted that the patient was able to move his right leg but no other part of his body. This observation was confirmed by the use of a peripheral nerve stimulator and by the patient's own recollections. It is suggested that this occurrence shows that the slow offset of neuromuscular block in patients with atypical pseudocholinesterases who have received suxamethonium is caused by long lasting effects at the neuromuscular junction rather than the continuing presence of suxamethonium in the plasma.
The onset time and tendency to cumulation of pipecuronium and high-dose vecuronium were studied during nitrous oxide anaesthesia supplemented with isoflurane. Pipecuronium 0.06 mg.kg-1 had a similar duration of action to vecuronium 0.015 mg.kg-1 (42 vs 49 min). Patients who received vecuronium had a shorter onset time of neuromuscular blockade (p less than 0.01). The use of pipecuronium was associated with marked cumulation.
The onset time and tendency to cumulation of pipecuronium and high-dose vecuronium were compared during nitrous oxide anaesthesia supplemented with a propofol infusion. Pipecuronium 0.06 mg.kg-1 had a similar duration of action to vecuronium 0.2 mg.kg-1 (49 vs 43). Patients who received vecuronium had a shorter onset time of neuromuscular blockade (p less than 0.01). Neither pipecuronium nor vecuronium showed marked cumulation.
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