Cord injury after spinal anaesthesia in a patient with previously undiagnosed Klippel-Feil syndrome.

This report presents an obstetric patient with no significant past medical history who underwent spinal anaesthesia for a category-three caesarean section. On examination, she had asymmetrical scapular alignment and a mild scoliosis of the lumbar spine with no functional limitation. Postoperatively the patient developed neuropathic pain symptoms in the right leg which failed to resolve with conventional analgesia. Cervical and lumbar spine magnetic resonance imaging was performed resulting in a diagnosis of a low-lying tethered spinal cord terminating at the level of L5 and congenital fusion of the C7/T1 vertebrae. A tethered spinal cord is a rare condition, which in this case had been completely asymptomatic. However, we suggest that the patient displayed musculoskeletal signs not previously widely reported, which could have indicated the presence of a potential underlying neural tube defect. Based on the imaging findings and the presence of Sprengel's deformity, the patient was diagnosed with Klippel-Feil syndrome.

Lung recruitment and positive airway pressure before extubation does not improve oxygenation in the post-anaesthesia care unit: a randomized clinical trial.

BACKGROUND: Atelectasis is known to develop during anaesthesia and after operation atelectasis leads to impaired oxygenation. Lung recruitment manoeuvres, positive end-expiratory pressure (PEEP), and continuous positive airway pressure (CPAP) have been proposed for reduction of atelectasis but their benefits have not been shown to persist after operation. We proposed that a combination of these techniques before extubation would improve oxygenation after operation. METHODS: Adult patients undergoing elective surgery requiring tracheal intubation and an arterial catheter were randomized to receive either: a lung recruitment manoeuvre of 40 cm H(2)O for 15 s, 30 min before the end of anaesthesia, followed by 10 cm H(2)O of PEEP and then 10 cm H(2)O of CPAP from return of spontaneous breathing until extubation; or no lung recruitment manoeuvre,

Analgesic effects on endogenous melatonin secretion.

Animal welfare concerns have led to increased demands for use of post-operative analgesia in association with experimental surgery. Such treatment is appropriate provided it has no effect on experimental parameters. In order to assess any effects of analgesics on endogenous melatonin production, groups of six ewes were bled at 30 min intervals for the first 4 hr of darkness a) without analgesic treatment and b) immediately after analgesic administration. Analgesics tested were ketoprofen, phenylbutazone (both non-steroidal anti-inflammatory drugs or NSAIDs) and buprenorphine (an opioid). Plasma melatonin was measured by radioimmunoassay and 4 hr secretion profiles computed for each animal. Ketoprofen and buprenorphine treatment reduced mean four hour melatonin secretion profiles by 50.6% (from 1,347.3 to 665.1 pg/ml.hr) and 38.6% (from 287.8 to 171.3 pg/ml.hr), respectively. Only in the case of phenylbutazone was the response not statistically significant; hence this drug has been selected as a post-operative analgesic for future experimental studies involving measurement of melatonin levels.