SummaryThyroid crisis on induction of anaesthesia was treated with dantrolene, because of a mistaken diagnosis of malignant hyperthermia. There was immediate improvement after dantrolene with reduction in muscle rigidity, mental confusion and pyrexia. High circulating T4 has an effect on calcium flux across the sarcoplasmic reticulum and dantrolene may inhibit this pathological mechanism. We suggest the same dosage regimen as is used in the treatment of malignant hyperthermia.
SummaryThe effect of neostigmine on neuromuscular function was examined after spontaneous recovery from an atracurium-induced neuromuscular blockade, which reached a train-of-four ratio of either 0.5 or 0.9. Two doses ofneostigmine 2.5 mg were given 5 minutes apart.
damage to the digital neurovascular bundle. The infected bones are excised and all septic tissue carefully debrided. The wound is washed, and the skin closed with interrupted sutures over a corrugated drain. The foot is dressed lightly with gelonet, wool and crepe bandage.Postoperatively, the patient should continue antibiotics and remain on bed-rest for 5 days, before being discharged with special well-padded surgical footwear.
DISCUSSIONThis technique saves the toe and heals rapidly. The conventional ray amputation often involves the sacrifice of healthy tissue, at the expense of a small area of ulceration next to the infected MTP joint. The mobile flail joint created quickly fills up with granulation and fibrous tissue, allowing a reasonable range of movement. This operation is useful in neuropathic diabetic foot ulcers over the MTP joint, where the blood supply is good, or when peripheral arterial disease has been rectified.
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