Hoarseness following brachial plexus block

A case is described in which the patient developed hoarseness following a left brachial plexus block, using the supraclavicular approach. Possible paralysis of the left recurrent laryngeal nerve is discussed. (AU)

Intravenous lignocaine prior to intubation effect on rhythm and changes in heart rate and rate pressure product - abstract

Tracheal intubation is frequently associated with occurrence of cardiac dysrhythmias and is almost always accompanied by increases in systolic and diastolic blood pressure. In some instances, these cardiovascular changes may lead to disastrous complications. A prospective study was undertaken to evaluate the efficacy of intravenous lignocaine prior to intubation in blunting the cardiovascular responses to intubation in a West Indian population. Seventy-five clinically fit patients (age range 20 -40 years, mean 27.5) were included. They were divided into 3 groups as follows: Group A: received 1 mg/kg lignocaine hydrochloride as I.V. bolus dose 1 min prior to induction of anaesthesia. Group B: - received 2mg/kg lignocaine, and Group C: - No ligocaine (control). Parameters recorded were heart rate (HR), cardiac rhythm (ECG), systolic and diastolic bloodpressure (BP), and (heart) Rate - (systolic) pressure product (RPP). These were measured at the following times: 1. Prior to induction of anaesthesia, 2. During laryngoscopy and intubation, 3: 1 min following intubation and 4: 5 mins following intubation. After the pre-induction parameters were recorded, lignocaine was given in 1 and 2 mg/kg doses in groups A & B patients. One minute following lignocaine, patients were anaesthetised using standard techique and the trachea was intubated. All parameters were again recorded, lignocaine was given in 1 and 2 mg/kg doses in groups A percent B patients. One minute following lignocaine, patients were anaesthetised using standard technique and the trachea was intubated. All parameters were again recorded at the stated times. Both the HRs and RPPs increased significantly in all the 3 groups following intubation. The increase in group B (2mg/kg) was significantly lower than in the control group. Group A patients (1mg/kg) did not show any consistent difference, statistically, compared to the control group. The incidence of dysrhythmias was 64 percent in the control group, 32 percent in group A patients (1mg/kg) and 12 percent in group B (2mg.kg). Seventy per cent of all dysrhythmias occurred at the time of laryngoscopy and intubation, consisting mainly of supra-ventricular and ventricular ectopics. Intravenous lignocaine prior to intubation decreases the incidence of dysrhythmias and also decreases the degree of rise in HRs and RPPs. Lignocaine at a dose of 2 mg/kg is better than a dose of 1 mg/kg (AU)

Central retinal artery occlusion without retrobulbar hemorrhage after retrobulbar anaesthesia

Four patients had central retinal artery occlusions after retrobulbar anaesthesia with lidocaine HCl was administered before photocoagulation. One of these four had two separate episodes of closure. Only one had permanent visual loss and none had evidence of retrobulbar hemorrhage. Each patient had a severe hematologic or vascular disorder. We think that direct trauma to the central retinal artery behind the globe, the pharmacologic or compressive effects of the injected solution,or both caused the occlusions in these patients. (AU)

Epidural analgesia during labour at the University Hospital of the West Indies

Thirty-two patients were given epidural analgesia during labour at the University Hospital of the West Indies. The majority were impressed by the quality of analgesia provided by the technique and have requested this form of pain relief for subsequent deliveries. The complications were few and transient. The advantages far outweighed the few disadvantages of the technique. It is hoped that a more frequent and widespread application of this satisfactory form of pain relief will be practised in hospitals throughout the West Indies (AU)

Prognosis of idiopathic cardiomegaly in Jamaica with reference to the coronary arteries and other factors

Clinical and epidemiological features of idiopathic cardiomegaly in Jamaica are reviewed, and the high community prevalence of the disorder is shown. The frequency occurrence of sudden or unexpected death in patients whose earlier electrocardiograms had shown repeated ventricular ectopic beats has been noted. Common electrocardiographic findings included a high rate of abnormalities usually regarded as indicative of coronary artery disease: cardiac arrhythmias, particularly multiple ventricular extrasystoles; and high voltage complexes characteristic of left ventricular hypertrophy. The differences and similarities between idiopathic cardiomegaly and coronary heart disease are shown. A possible role for intramuscular lignocaine in the control of the chronic ventricular ectopic rhythms is demonstrated. There is a statistically significant association between idiopathic cardiomegaly and positive serological tests for treponemal infection. The hearts are invariably hypertrophied at necropsy. In some hearts the smaller intramuscular coronary arteries show occlusive changes. Their possible nature and significance are discussed.(AU)