The effect of increasing degrees of spinal flexion on cerebrospinal fluid pressure.

The effects of increasing degrees of flexion on cerebrospinal fluid pressure were investigated in 12 neurosurgical patients requiring lumbar subarachnoid drains. Cerebrospinal fluid pressure and central venous pressure were measured in three positions: fully flexed ('chin on chest'), flexed at ninety degrees and straight. There was a significant increase in cerebrospinal fluid pressure on moving from the fully flexed to the flexed position (p < 0.0001), but not from the flexed to the straight position. These results were mirrored by smaller changes in central venous pressure. In patients without intracranial pathology these increases in cerebrospinal fluid pressure are probably unimportant. However, intracranial pathology may result in low cerebral perfusion pressures and any increase in cerebrospinal fluid pressure in this group may be harmful. The fully flexed position should be avoided when inserting lumbar drains in at risk patients.

The effect of propofol sedation in pregnancy on neonatal condition.

A woman who suffered an intracerebral haemorrhage secondary to Moyamoya disease in her 33rd week of pregnancy was sedated for ventilation with propofol for 48 h until she underwent emergency Caesarean section. There appeared to be no adverse metabolic effects on the neonate from the use of propofol in the mother although sedation was prolonged.

Full recovery following massive overdose with insulin and thyroxine.

Specific treatment is available for only a few substances taken in overdose. We report here a patient who attempted suicide with a massive overdose of insulin and thyroxine, a combination not previously reported, and discuss the specific treatments given to mitigate the harmful effects of this combination.