Grade 1C)'. It assumes equal risk for a lumbar plexus block when compared with an upper limb plexus block and does not consider the potential benefits of ultrasound in mitigating vascular injury.In the absence of robust evidence, it is our assertion that, by identifying current practice across the country, confidence can be gained that we are operating in a way similar to our colleagues. Thus, it allows the application of the Bolam principle. For upper limb blocks, the authors recommend:(i) ultrasound-guided technique in patients with altered coagulation; (ii) INR ,2.5 (88% concordance); (iii) platelet count ≥50 000 (65% concordance); (iv) concomitant use of clopidogrel is not necessarily a contraindication (50% concordance); (v) a national audit project similar to the Royal College of Anaesthetists' third national audit project, identifying major complications of central neuraxial blockade, would be of benefit.
A sixty-year-old female presented to the emergency department with a perforated duodenal ulcer. Whilst awaiting surgery she developed chest pain and ST segment changes consistent with an inferior myocardial infarction. It was considered necessary to continue with surgical management, however general anaesthesia was complicated postoperatively by an episode of pulseless ventricular tachycardia, that appeared to be triggered by intravenous metaraminol. Subsequent coronary angiography demonstrated no evidence of coronary artery disease but findings were suggestive of Takotsubo cardiomyopathy, which was probably exacerbated by intravenous metaraminol.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.