%0 Journal Article
%~ Pubmed
%A Phillips, S
%A Stewart, Pa
%A Freelander, N
%A Heller, G
%T Comparison of evoked electromyography in three muscles of the hand during recovery from non-depolarising neuromuscular blockade.
%B Anaesthesia and Intensive Care
%D 2012
%V 40
%N 4
%P 690-969
%@ 0310-057X
%X The evoked electromyographic responses to supramaximal train of four stimulation of three muscles, all innervated by the ulnar nerve, were compared during recovery from non-depolarising neuromuscular blockade. The abductor digiti minimi was the most resistant to neuromuscular blockade (P <0.001) and the most repeatable (repeatability coefficient 4.4%) when compared with the adductor pollicis (5.9%) and the first dorsal interosseous (5.8%). The abductor digiti minimi had a bias of 0.1 compared to the adductor pollicis and first dorsal interosseous and its limits of agreement were more acceptable (-0.10 to 0.30) at a train of four ratio of 0.9. The electromyography train of four of the adductor pollicis and first dorsal interosseous at 0.8 is equivalent to an electromyography train of four of 0.9 at abductor digiti minimi.
%Z FOR Codes: 1103 1004



%0 Journal Article
%~ Pubmed
%A Phillips, S
%A Falk, G L
%T Surgical tension pneumothorax during laparoscopic repair of massive hiatus hernia: a different situation requiring different management.
%B Anaesthesia and Intensive Care
%D 2011
%V 39
%N 6
%P 1120-3
%@ 0310-057X
%X During laparoscopic repair of massive hiatus hernia, surgical dissection can breach the parietal pleura allowing insufflating carbon dioxide to rapidly expand the pleural space, causing a tension pneumothorax. This extrapulmonary pneumothorax involves no damage to the lung parenchyma. Its rapid resolution is aided by the high solubility of carbon dioxide and it will not refill once the procedure is completed. In this series of 50 massive hiatus hernia repairs the incidence of pneumothorax was 22% (11/50), with two of these being bilateral. Cardiovascular compromise occurred in 91% of those (10/11). The aetiology, pathophysiology and management of this intraoperative capnothorax differ significantly from that of a pneumothorax secondary to lung trauma or occurring during other types of laparoscopy. Understanding the relevant pleural anatomy and pathophysiology of this condition allowed conservative management in all cases and avoided the need for chest drains, open surgery or abandonment of the procedure.
%Z FOR Codes: 110301 110323