atraumatic neuromuscular

Electroconvulsive therapy (ECT) utilises the electrical induction of a generalised seizure for treating severe mental disorders. The treatment, developed in 1938, is neglected especially in Germany. This is partly due to the original application in non-anaesthetised patients resulting in many atraumatic side effects. Since the beginning of the sixties, "modified" ECT under anaesthesia with neuromuscular blockade has become worldwide standard. Controlled studies showed that in major depression ECT is at least equal to pharmacotherapy with relatively few adverse side effects...

PURPOSE: To describe negative pressure injury occurring during the use of a laryngeal mask airway (LMA) in which airway bleeding rather than pulmonary oedema was the major complication. CLINICAL FEATURES: A patient presented to the day surgery unit for resection of a ganglion cyst on her right wrist. She underwent general anaesthesia using an LMA, and experienced severe laryngospasm and transient hypoxaemia (oxygen saturation to 66%) seven minutes after incision...

Many of the diagnostic advances in the field of myopathies have been achieved by the examination of samples of muscle removed by biopsy. A muscle selected for biopsy must be obtained atraumatically with the fibres orientated longitudinally. Artefacts are avoided by freezing the sample in liquid nitrogen. The typing of muscle fibres by using the ATPase and dehydrogenase reactions is of advantage to the interpretation of muscle diseases. An accurate method for the determination of changes in the size of muscle fibres is a must...

Ninety cases of bilateral dislocation of the shoulders, including seven previously unreported cases are discussed. Forty-nine per cent were due to convulsive seizures or electrocution, 23 per cent were traumatic and 36 per cent were atraumatic. This paper indicates that many attributed to trauma were probably due to unrecognized seizure, and neurological examination is indicated in all cases. Dislocations as a result of seizures or electrocution were often diagnosed late.

Muscle biopsy is often incorrectly performed despite the fact that it is a relatively simple procedure. A consistently reproducible surgical technique in 93 open vastus lateralis muscle biopsies implemented in conjunction with neuromuscular and malignant hyperthermia research demonstrated 14 cases of malignant hyperthermia and a variety of forms of neuromuscular pathology. No wound complications or disabilities have resulted from this procedure. The procedure includes careful selection of biopsy site, regional anesthesia, atraumatic dissection, and immediate processing of the biopsy sample...

Sophisticated techniques for electrical stimulation of excitable tissue to treat neuromuscular disorders rationally have been developed over the past 3 decades. A historical review shows that electricity has been applied to the phrenic nerves to activate the diaphragm for some 200 years. Of the contemporary methods for stimulating the phrenic nerve in cases of ventilatory insufficiency, the authors prefer stimulation of the phrenic nerve in the thorax using a platinum ribbon electrode placed behind the nerve and an attached subcutaneously implanted radiofrequency (RF) receiver inductively coupled to an external RF transmitter...

Four children investigated for neuromuscular disorder by routine ultrasound imaging showed selective involvement within the quadriceps femoris muscle, with involvement of the vasti and sparing of the rectus femoris. This was confirmed by concurrent needle biopsy of the two muscles. Real-time ultrasound imaging is quick, noninvasive, readily accepted by children, and has the advantage over CT scans of being practical for routine outpatient use. Needle biopsy is relatively atraumatic and enables one to select specific superficial and deep muscles for concurrent biopsy...

The results of a study utilizing computerized real-time sonography (CRS) to image muscles in patients with neuromuscular disease are presented for 67 patients, 37 with neuromuscular disease and 4 with upper motor neuron disease, and 26 age-matched healthy controls between the ages of 2 days and 59 years. CRS is a safe, noninvasive, atraumatic method for evaluating a broad range of neuromuscular diseases. It is capable of differentiating myopathies or dystrophies from neurogenic atrophies and floppy infants with "central" hypotonia from those with neuromuscular diseases...

The onset of neuromuscular blockade following the i.v. injection of vecuronium and pancuronium 0.05, 0.08 or 0.1 mg/kg and suxamethonium 0.5 or 1.0 mg/kg was studied in 304 patients during induction of anaesthesia by means of the compound action potential derived from the adductor pollicis muscle, which was indirectly stimulated via the ulnar nerve. The intubation conditions 1-5 min after injection were assessed using a scoring system related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of extremities...

A 75-year-old woman underwent panendoscopy and excision of a neck "lump". After antagonism of residual neuromuscular block and extubation of the trachea, she developed recurrent upper airway obstruction and stridor, necessitating a permanent tracheostomy. The possibility of vagal nerve involvement or injury should always be considered during excision of neck lumps. Preoperative indirect, atraumatic laryngoscopy by experienced surgeons is essential, as are tracheal intubation and vigilant postoperative observation...

STUDY OBJECTIVES: To determine the effect of priming on the intubation and onset times of vecuronium 0.3 mg/kg. DESIGN: Randomized, unblinded study. SETTING: Operating rooms and postanesthetic recovery unit of a university-affiliated general hospital. PATIENTS: Thirty female ASA physical status I and II patients scheduled for intraperitoneal surgery divided into two groups of 15 each. INTERVENTIONS: Anesthesia was induced and maintained with sufentanil, droperidol, thiopental sodium, and nitrous oxide in oxygen...