Sperm function and structure and seminal plasma prostanoid concentrations in men with IDDM. Diabetes Care 1989;12:742-4. 67 Badenoch DF, Evans SJW', McCloskey DJ. Sperm density measurement:should this be abandoned? Br] Urol 1989;64:521-3.68 Pol PS. Beuscart R, Leroy-Martin B, Hermand E, Jablonski W. Circannual rhythm of sperm parameters of fertile men. Fertil Steril 1989;51:1030-3. 74 Osterlind A. Diverging trends in incidence and mortality of testicular cancer in Denniark, 1943-1982. Br7 Cancer 198653:501-5. 75 Brown LM, Pottern LM, Hoover RN, Devesa SS, Aselton P, Flannery JT.Testicular cancer in the United States: trends in incidence and mortality. IntJEpidemiol 1986;15:164-70. 76 Hakulinen T, Andersen AA, Malker B, Pukkala E, Schou G, Tulinius H.Trends in cancer incidence in the Nordic countries. APMIS 1986;suppl 288.
Percutaneous dilatation tracheostomy has become a common procedure for bedside insertion of tracheostomy tubes in the intensive care unit. Management of the airway during the procedure using the laryngeal mask airway (LMA) and other methods has been described. The intubating laryngeal mask airway has several potential benefits for airway management during percutaneous dilatation tracheostomy compared with the LMA. These include the use of both the fibreoptic bronchoscope and tracheal tube if necessary. We report the results of a pilot study of 10 patients that illustrates these advantages.
SummaryThree adults are described who developed life-threatening hypotension following intravenous codeine phosphate. It is recommended that codeine phosphate should not be given intravenously to adults. Key wordsAnalgesics; codeine phosphate. Complications; hypotension.Codeine phosphate has retained a place in the treatment of moderate pain, despite the availability of new, highly potent synthetic opioids with minimal unpredictable adverse effects. In addition it is a popular analgesic for neurosurgical patients because of its relative lack of sedation and interference with pupillary size. The parenteral preparation of codeine phosphate currently available bears a label listing the intravenous route of administration as an alternative to intramuscular injection. Adverse reactions to intravenous codeine phosphate have been described in children, in whom its use is not recommended [ l]. We describe three adults who developed severe hypotension following intravenous codeine phosphate. Case histories Case IA 17-year-old male, weighing 51 kg, was scheduled for six dental extractions, as a day case. He had previously been investigated for short stature but no cause had been found. He had received two uneventful anaesthetics for squint correction and tonsillectomy some years before.He was prescribed no premedication. Anaesthesia was induced with alfentanil, thiopentone and suxamethonium, and following tracheal intubation was allowed to breathe spontaneously an oxygen/nitrous oxide/enflurane mixture. The patient remained stable throughout surgery, and at the end of the procedure his systolic blood pressure was 120 mmHg, which was identical to the pre-induction value. Codeine phosphate injection 50 mg (McCarthy 60 mg.ml-I) was then given, undiluted, intravenously as a bolus. Almost immediately the patient became pulseless and grey, but the electrocardiograph (ECG) continued to show sinus rhythm at a rate of 90 beat.min-l. The patient's lungs were ventilated with 100% oxygen and external cardiac massage started. Adrenaline (I mg) was given intravenously. After 60 s the pulse became palpable and systolic blood pressure was measured at 40mmHg. The patient remained in sinus rhythm at a rate of 90beat.min-'. Ephedrine 15 mg and atropine 0.6 mg were administered intravenously and 4 min later the systolic blood pressure was 70mmHg, but a further 5 min elapsed before the systolic blood pressure reached 100 mmHg (Fig. 1). At no time did any bronchospasm or rash develop, and there was no increase in body temperature. The patient's trachea was extubated and he was admitted for observation overnight. He remained stable and his ECG was normal. He was discharged the next day, fully recovered, with written instructions that he was allergic to codeine phosphate injection. Case 2A previously fit, 16-year-old female was scheduled for myringoplasty. She was premedicated with lorazepam. Anaesthesia was induced with thiopentone and vecuronium and maintained with enflurane in nitrous oxide and oxygen
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.