SummaryThe changes in intra-ocular pressure associated with two dgferent anaesthetic induction and tracheal intubation techniques were conipared (n = 30). After pre-oxygenation, Group A received thiopentone ( 5 mglkg) followed by suxamethonium (1.5 Patients with penetrating eye injuries may present for surgery with a potential full stomach and in this situation many anaesthetists would choose a rapid sequence induction. Suxamethonium remains the relaxant of choice for this technique, but its use is accompanied by an increase in intra-ocular pressure (IOP).1-3 A number of studies4~~' have invcstigatcd the substitution of atracurium or vecuronium for suxamethonium. However, this has not eliminated increases in IOP above baseline value^^'^ and is associated with othcr disadvantages. These are an increased delay in obtaining full r e l a x a t i~n ;~~~~~ suboptimal intubating condition^;^-' ' administration of thc relaxant 20-30 seconds before induction,'-' and a lowered safety margin in railed intubation. One previous paper only'2 has conipared the IOP changes when suxamethonium or atracurium was used for rapid sequence induction. The authors contined their conclusions to the suitability of atracurium in rapid sequence induction but there was evidence that suxamethonium could be associated with only minimal elevations in IOP. Our study thereforc furthcr invcstigatcs thc changes in IOP when thiopentone and suxamethonium or thiopentone and atracurium are used for induction and intubation.
MethodsThirty patients in ASA groups 1 or 2 and aged 16-65, who required tracheal intubation for nonophthalmic surgery were included in the study; all gave informed consent which had ethics committee approval. Hypertensive patients and those with known ocular discasc wcrc cxcludcd. Premcdication was with papaveretum 0.3 mgikg and hyoscine 0.06 nigikg intramuscularly one hour bcforc anacsthesia. Baseline IOP, arterial blood pressure and pulse were recorded on arrival in the anaesthetic room. Baseline IOP was measured in the right eye with the patient supine, using a Perkins hand-held applanation t~n o m e t e r . '~ All readings were taken after the topical instillation of lignocaine and flourescein eye drops and performed by one of the authors (L.L.), who was unaware of the anaesthetic agents used. All patients were pre-oxygenated for 2 minutes before induction and allocated randomly to one of two groups.
Hypokalaemia is a relatively common biochemical abnormality found at the emergency department. Sequential changes in the electrocardiogram occur as the serum potassium is lowered. Correction of hypokalaemia can be life-saving. It is essential for physicians to be able to recognise these changes and initiate prompt replacement when necessary. We present a case series of patients presenting to the emergency department with symptomatic hypokalaemia and discuss the electrocardiographic manifestations and recognition of hypokalaemic changes.
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