There has been a recent renewal of interest in the use of monoamine oxidase inhibitors in psychiatry. The concurrent administration of anaesthetic agents, particularly narcotic analgesics, is often a cause for concern. Although many monoamine oxidase inhibitor-drug interactions have been reported, in practice it is only the interaction with pethidine which has led to fatalities. What is not appreciated is that the monoamine oxidase inhibitor-pethidine interaction has two distinct forms-"excitatory" and "depressive". It is this lack of appreciation that has led to much confusion when dealing with patients taking monoamine oxidase inhibitors.
The records of 3011 obstetric extradural blocks were examined to determine the depth of the extradural space and the relative risk of dural puncture. The overall incidence of dural puncture was 0.7%. A disproportionate number of punctures occurred when the space was superficial (1.45%), with a risk factor three times greater than that associated with normal depth spaces (0.48%). Caution is advised when infiltrating with local anaesthetics before extradural procedures, and when initially introducing the extradural needle.
Hydrogen peroxide solution is commonly used for irrigating and cleaning wounds. It has some germicidal properties and may remove contaminants mechanically. When it is applied to tissues catalase causes its rapid molecular decomposition with the release of oxygen bubbles (1 ml of hydrogen peroxide 3% (10 vol) will release 10 ml oxygen Laparotomy showed a perforated sigmoid diverticulum with an abscess extending behind the pubis and laterally into the left leg. The diseased bowel was excised and colostomy performed. Anaesthesia proceeded uneventfully, and his systolic blood pressure was stable at 110-120 mm Hg with a heart rate of 110 beats/minute. Estimated blood loss was 500 ml. He had received Hartmann's solution one litre, human plasma protein fraction 500 ml, and dextrose 4% and saline 0-18% 500 ml. At this stage an incision was made in his thigh over the greater trochanter and copious quantities of pus drained from beneath the fascia lata. Hydrogen peroxide 3% (200 ml), was syringed into the wound and up into the abscess cavity under the fascia lata. After pressing on the thigh to express the hydrogen peroxide and pus the surgeon packed the wound. At this point the end tidal carbon dioxide partial pressure dropped during three breaths to 15 mm Hg, and during the next minute the patient developed cyanosis, tachycardia (150 beats/minute), and hypotension (80/40 mm Hg). After a check to ensure that he was being adequately ventilated and that the anaesthetic equipment and gas supplies were functioning correctly an oxygen embolus was diagnosed.Fractional inspired oxygen concentration was increased to 1-0, and dexamethasone 8 mg and whole blood 400 ml were given intravenously. His cyanosis improved during the next three minutes, and pulse and blood
Ebstein's anomaly is a rare congenital malformation of the tricuspid valve, often associated with an atrial septal defect. Death occurs usually from cardiac arrhythmias. The successful use of a two-catheter technique for elective Caesarean section with extradural analgesia is described and the hazards associated with Ebstein's anomaly in pregnancy and anaesthesia are discussed.
We report a case that showed many of the features of the malignant hyperpyrexia syndrome following suxamethonium administration, in an unsuspected case of pseudohypertrophic (Duchenne) muscular dystrophy
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