Showing papers in "BJA: British Journal of Anaesthesia in 1971"
TL;DR: The rationale is presented for the prophylactic blockade of beta-adrenergic receptors to prevent hypertensive crises during laryngoscopy and intubation in both treated and untreated hypertensive patients.
Abstract: The electrocardiographic and haemodynamic responses to the induction of anaesthesia, followed by laryngoscopy and endotracheal intubation have been studied in a group of 16 untreated hypertensive patients, and a group of 20 patients receiving antihypertensive therapy up to and including the day of operation. The influence of five different induction agents, thiopentone, methohexitone, propanidid, diazepam, and neuroleptanalgesia induced by a combination of phenoperidine and droperidol were compared. Neuroleptanalgesia caused less arterial hypotension than any of the other agents, but afforded only marginally more protection than other agents against hypertension, tachycardia and dysrhythmia associated with laryngoscopy and tracheal intubation. Both propanidid and diazepam caused dramatic but transient hypotension in a small number of patients and were not investigated further. Unlike its effects in normotensive subjects, methohexitone caused greater hypotension than thiopentone in hypertensive patients. The rationale is presented for the prophylactic blockade of beta-adrenergic receptors to prevent hypertensive crises during laryngoscopy and intubation in both treated and untreated hypertensive patients.
485 citations
TL;DR: It is concluded that untreated high arterial pressure constitutes a serious risk to patients undergoing anaesthesia and surgery, and therefore anti-hypertensive therapy should not be withdrawn prior to anaesthesia without a compelling reason.
Abstract: The cardiovascular responses to the induction, maintenance, and recovery from anaesthesia with thiopentone, nitrous oxide and halothane, have been studied in seven elderly normotensive patients, seven untreated hypertensive patients, and fifteen patients under treatment with a variety of anti-hypertensive drugs. In five untreated and three treated hypertensive patients, all of whom had high arterial pressures before anaesthesia, severe reduction of arterial pressure occurred during anaesthesia and was associated with electrocardiographic evidence of myocardial ischaemia. Other treated hypertensive patients, whose arterial pressures were well controlled, behaved in a similar manner to the normotensive patients, and gave no ground for concern during anaesthesia. Cardiac output fell to the same extent (30 per cent) in all three groups, and where a great reduction of arterial pressure occurred it was largely due to reduction of initially high systemic vascular resistance. Baroreflex control of heart rate was significantly depressed in hypertensive patients both before and during anaesthesia. It is concluded that untreated high arterial pressure constitutes a serious risk to patients undergoing anaesthesia and surgery, and therefore anti-hypertensive therapy should not be withdrawn prior to anaesthesia without a compelling reason.
343 citations
TL;DR: Glaxo CT1341 is a new steroid anaesthetic that produces immediate induction of anaesthesia of short duration when injected intravenously into experimental animals and recovery is rapid and uncomplicated.
Abstract: SUMMARY Glaxo CT1341 is a new steroid anaesthetic. It produces immediate induction of anaesthesia of short duration when injected intravenously into experimental animals and recovery is rapid and uncomplicated. It has a high therapeutic index and has proved compatible with the adjuvant and pre-anaesthetic drugs, inhalational anaesthetics and neuromuscular blocking drugs commonly employed in anaesthesia. It is free from vascular irritation effects even when administered intra-arterially.
228 citations
TL;DR: An attempt to estimate residual neuromuscular blockade after the administration of anti-depolarizing relaxants to anaesthetized patients is described and clinical recovery from the relaxant was assessed by the ability to lift the head.
Abstract: An attempt to estimate residual neuromuscular blockade after the administration of anti-depolarizing relaxants to anaesthetized patients is described. A train of four supra-maximal nerve stimuli was applied to the ulnar nerve and the twitch response (mechanical or electrical) was recorded. The frequency of the train used was 2–2.4 Hz with an interval of 10 seconds between the trains. Clinical recovery from the relaxant was assessed by the ability to lift the head. The ratio of the height of the fourth response of the train to that of the first (ratio (c)) gave a good indication of the degree of residual neuromuscular block as indicated by this simple clinical test. As ratio (c) increased muscle power improved. Obvious muscle weakness was associated with values of ratio (c) of less than 0.6.
182 citations
TL;DR: The conventional use of narcotics for postoperative analgesia increases the risk of lung morbidity and extradural nerve block was found to reduce the degree of postoperative lung dysfunction.
Abstract: Twenty-one patients for vagotomy with gastroenterostomy or pyloroplasty were allocated randomly to postoperative analgesia with either morphine by injection or continuous extradural nerve block. In terms of clinical assessment and A–a Po2 difference measured before and after operation, extradural nerve block was found to reduce the degree of postoperative lung dysfunction. It is concluded that the conventional use of narcotics for postoperative analgesia increases the risk of lung morbidity.
159 citations
TL;DR: There was a marked and statistically significant increase of heart rate, accompanied by lesser, but still statistically significant, incerases of cardiac output and mean arterial blood pressure, suggesting that pancuronium has little ganglion-blocking activity.
Abstract: SUMMARY We have investigated the effects of pancuronium bromide (0.07 mg/kg body weight) on heart rate, mean arterial blood pressure, cardiac output and calculated total peripheral resistance in ten artificially ventilated patients, anaesthetized with 60 per cent nitrous oxide in oxygen plus phenoperidine (1 mg/15 kg body weight). End-tidal Pco2 was maintained constant at 30±2 mm Hg. There was a marked and statistically significant increase of heart rate of about 25 per cent, accompanied by lesser, but still statistically significant, incerases of cardiac output and mean arterial blood pressure. Total peripheral resistance was unchanged, suggesting that pancuronium has little ganglion-blocking activity.
122 citations
TL;DR: It is confirmed that lower oesophageal temperature readings will give an approximate indication of the cerebral temperature in the absence of an open thorax or a rapid transfusion of cold blood.
Abstract: It is confirmed that lower oesophageal temperature readings will give an approximate indication of the cerebral temperature in the absence of an open thorax or a rapid transfusion of cold blood. Nasopharyngeal readings are less reliable and should not be used on their own. Middle and upper oesophageal recordings are unsatisfactory because of ventilatory cooling. For an assured accuracy greater than ± 1.0°C, direct intracerebral readings are necessary. The brain at a depth of 4 cm is usually slightly warmer than the lower oesophagus or nasopharynx. More superficial readings may be affected by the ambient temperature and surgical procedures
100 citations
Journal Article•
92 citations
Journal Article•
92 citations
TL;DR: It is concluded that droperidol is a potent cerebral vasoconstrictor, that this effect dominates when it is given in combination with fentanyl, that hypocapnia causes little further reduction in c.b.f., and that the reduction produced by Innovar is not accompanied by alterations in normal cerebral metabolic pathways.
Abstract: The effects of droperidol and fentanyl given individually and in combination (Innovar) on the rate of cerebral oxygen consumption (CMRo,) and cerebral blood flow (c.b.f.) were studied in dogs anaesthetized with nitrous oxide (70 percent) and oxygen. Fentanyl (0.006 mg/kg) decreased both the CMRo, and the c.b.f. (mean decreases at 15 minutes were 18 per cent and 47 percent, respectively). The duration of effect was approximately 30 minutes. Droperidol (0.3 mg/kg) produced a decrease of 40 per cent in c.b.f. due primarily to a 30-40 per cent increase in cerebrovascular resistance, and this effect persisted for the period of observation (60 minutes). No significant change in CMRo, occurred after droperidol was administered. With the combination drug (Innovar), the effects were partially additive. After 15 minutes, CMRo, had decreased 23 per cent; c.b.f. had decreased 50 per cent; and cerebral vascular resistance had increased 85 per cent. After 30 minutes, the effects of Innovar were indistinguishable from those of droperidol alone. No significant changes occurred in the rate of cerebral glucose consumption or the oxygen-glucose index. The effect of increased and decreased Paooj on c.bi. after Innovar was compared widi that observed during halothane anaesthesia. With halothane, hypercapnia (Pacoi=60 tnm Hg) increased c.b.f. 40 per cent and hypocapnia (Pace = 20 mm Hg) decreased c.b.f. 40 per cent. Innovar at normocapnia reduced the c.b.f. 65 per cent. With hypercapnia, the c.bi. doubled, but with hypocapnia, little further reduction in c.b.f. occurred. It is concluded that droperidol is a potent cerebral vasoconstrictor, that this effect dominates when it is given in combination with fentanyl, that hypocapnia causes little further reduction in c.b.f., and that the reduction in c.bi. produced by Innovar is not accompanied by alterations in normal cerebral metabolic pathways
83 citations
TL;DR: In this article, the effects of a new steroid anaesthetic agent (CT1341) were studied in twenty volunteers divided into three groups, in which serial measurements were made of heart rate, blood pressure and respiratory rate.
Abstract: SUMMARY The effects of a new steroid anaesthetic agent (CT1341) were studied in twenty volunteers divided into three groups. In group I, serial measurements were made of heart rate, blood pressure and respiratory rate. In group II, detailed haemodynamic studies were made in patients undergoing diagnostic cardiovascular investigations. These studies included measurement of cardiac output, stroke volume and arterial blood gases. In group III, time from induction to “true recovery” was measured following a single intravenous injection of the drug. This agent produced a stable anaesthetic state in all cases. Anaesthesia was characterized by a rise in respiratory rate and pulse rate with a slight fall in systolic and diastolic blood pressure. A significant fall in Pao2 occurred in those patients breathing air. The mean recovery time in six patients was 24.3 min. CT1341 produced safe and stable anaesthesia in all twenty cases and is worthy of further clinical trial.
TL;DR: It has been demonstrated that the introduction of methoxyflurane into the standard technique, in the manner described, results in a marked reduction in the incidence of awareness and a marked and significant reduction inThe incidence of unpleasant dreams.
Abstract: Two techniques of anaesthesia have been compared. The first (control group) consisting of premedication with hyoscine 0.6 mg, induction with thiopentone 250 mg and suxamethonium 100 mg, and maintenance with 67 per cent nitrous oxide with oxygen (using a Howells ventilator) and a suxamethonium infusion. In the study group exactly the same technique was used with the addition of methoxyflurane (0.1 per cent) after delivery of the infant by elective or emergency section or vaginally, or throughout the operation of postpartum sterilization. Attention has been focused on the incidence of awareness and dreaming during operation. It has been demonstrated that the introduction of methoxyflurane into the standard technique, in the manner described, results in a marked reduction in the incidence of awareness and a marked and significant reduction in the incidence of unpleasant dreams. Some of the implications of this modification are discussed.
TL;DR: It is uncertain whether adrenaline offered a significant advantage except with large doses of bupivacaine, when it reduced the likelihood of maternal intoxication, unless the second stage necessitated increased doses.
Abstract: Continuous epidural analgesia has been provided for eighteen patients during the first and second stages of labour. Nine patients received bupivacaine 0.5 per cent with adrenaline 5 μg/ml, and nine bupivacaine alone, using a double-blind technique. The initial dose of bupivacaine was 30 mg, repeated and increased as necessary. A total of fifty-nine doses was given. Plasma concentrations of bupivacaine were measured in the mother throughout the blockade, and in the baby at delivery. The duration of action of bupivacaine was not significantly prolonged by adrenaline, though plasma concentrations were significantly reduced 20 minutes after the first dose and 40 minutes after the second. In neither treatment group did bupivacaine accumulate markedly in maternal plasma unless the second stage necessitated increased doses. Neonatal bupivacaine concentrations were always low and neonatal: maternal ratios increased by the use of adrenaline. It is thus uncertain whether adrenaline offered a significant advantage except with large doses of bupivacaine, when it reduced the likelihood of maternal intoxication.
TL;DR: It is suggested that suxamethonium-induced hyperkalaemia would be a likely explanation for cardiac arrest in an apparently healthy boy during anaesthesia and some time later he was found to be suffering from the pseudohypertrophic (Duchenne) form of muscular dystrophy.
Abstract: SUMMARY Cardiac arrest occurred in an apparently healthy boy during anaesthesia. He was resuscitated but some time later was found to be suffering from the pseudohypertrophic (Duchenne) form of muscular dystrophy. The possible causes of circulatory collapse in this patient are considered and it is suggested that suxamethonium-induced hyperkalaemia would be a likely explanation.
TL;DR: If clinically occurring blood concentrations are compared with those associated with toxic symptoms during intravenous infusion in man, the margin of safety appears wider with bupivacaine than with lignocaine or mepavacaine.
Abstract: Bupivacaine 0.5 per cent with adrenaline 5 μg/ml was given to ten patients, and a combination of bupivacaine, lignocaine and mepivacaine (0.25 per cent of each) to four patients, to provide epidural blockade for surgery, and the blood concentrations of local analgesics were measured by gas chromatography. When comparing different drugs, both given individually (and the results expressed as a function of dosage) and given in an equal dose mixture, bupivacaine consistently produced the lowest blood concentrations and mepivacaine the highest. If clinically occurring blood concentrations are compared with those associated with toxic symptoms during intravenous infusion in man, the margin of safety appears wider with bupivacaine than with lignocaine or mepivacaine.
TL;DR: It is considered that further support is given to the value of sodium nitroprusside as a safe agent for use in controlled hypotensive anaesthesia.
Abstract: Sodium nitroprusside in 0.01 per cent solution was used to induce arterial hypotension in twenty-four consecutive craniotomies for cerebral aneurysm and arteriovenous malformations. The mortality and morbidity for patients with arteriovenous malformation and grade I and II aneurysm compared favourably with previous experience in this Institute using other methods. The results in patients with grade HI and grade IV aneurysms were not improved. It is considered that further support is given to the value of sodium nitroprusside as a safe agent for use in controlled hypotensive anaesthesia
TL;DR: Careful pre-operative evaluation, meticulous intra-operative management, and close postoperative observation of these patients regarding adequacy of the airway are essential.
Abstract: SUMMARY Three cases of airway difficulties associated with acromegaly are presented. Acromegalic features, with generally thickened tissues in the upper airway, predispose to airway obstruction. This potential difficulty, especially greater during anaesthesia, has not received the attention it warrants in the anaesthetic literature. Careful pre-operative evaluation, meticulous intra-operative management, and close postoperative observation of these patients regarding adequacy of the airway are essential.
TL;DR: Oxygen consumption during bypass at normothermia, whether before or after cooling, was 84 per cent of the pre-anaesthesia value, due possibly to the effects of muscle relaxation.
Abstract: SUMMARY Oxygen consumption was measured during hypothermic total body perfusion in twenty-seven patients undergoing cardiac operations. In nine patients it was also measured immediately before induction of anaesthesia. Fourteen patients were kept at normal temperature for from 5 to 17 minutes after bypass began; the rest were cooled immediately to 30 °C. Oxygen consumption during bypass at normothermia, whether before or after cooling, was 84 per cent of the pre-anaesthesia value, due possibly to the effects of muscle relaxation. During hypothermia, patients who were cooled immediately had an oxygen consumption which was about 15 per cent lower than that found in the patients with delayed cooling. Even in the latter group, oxygen consumption during hypothermia probably did not quite meet requirements, since it was shown to be positively correlated with blood flow.
TL;DR: Stimulation of the sympatho-adrenal system via the fifth cranial nerve in the presence of halothane anaesthesia is considered to be the main factor in the production of these dysrhythmias.
Abstract: Two hundred and three male patients undergoing oral surgery were monitored for abnormalities of cardiac rhythm. Eight per cent of a smaller number of patients (seventy-six) developed ectopic rhythms during induction of anaesthesia and in half of all patients nodal rhythm was seen. Twenty-three per cent developed ectopic rhythms in response to surgery. In three per cent of patients these were of the "chaotic" type. Most of the ectopic rhythms were nodal (supraventricular) in origin. Stimulation of the sympatho-adrenal system via the fifth cranial nerve in the presence of halothane anaesthesia is considered to be the main factor in the production of these dysrhythmias. Their significance is discussed
TL;DR: The evidence presented suggests that, in man, droperidol may be an adrenergic blocking agent and does not contradict the hypothesis that its action is mediated by blockade of alpha-adrenergic receptors.
Abstract: This study shows the effect of droperidol on the arterial pressure in patients who were undergoing heart surgery with cardiopulmonary bypass, translumbar aortography or vascular surgery. Intravenous injection of droperidol caused a transient fall in systemic arterial pressure. Direct injection into the aorta caused an immediate reduction in arterial pressure which was due to the direct action of the droperidol on the peripheral vessels. Injection into the oxygenator during cardiopulmonary bypass caused a transient reduction in arterial pressure, and when the effect of droperidol was maximal, peripheral vasoconstriction produced by adrenaline and noradrenaline was completely suppressed or severely attenuated for a period sometimes exceeding 10 minutes. The evidence presented suggests that, in man, droperidol may be an adrenergic blocking agent and does not contradict the hypothesis that its action is mediated by blockade of alpha-adrenergic receptors.
TL;DR: Electroencephalographic activity was monitored in dogs during anaesthesia with Ethrane, fluroxene, halothane, chloroform, divinyl ether, diethyl ether, methoxyflurane, cyclopropane and Forane to determine whether seizure activity occurred.
Abstract: Electroencephalographic (e.e.g.) activity was monitored in dogs during anaesthesia with Ethrane, fluroxene, halothane, chloroform, divinyl ether, diethyl ether, methoxyflurane, cyclopropane and Forane to determine whether seizure activity occurred. Four or more dogs were anaesthetized with each agent. Electroencephalographic tracings were obtained at m.a.c. and increasing multiples of m.a.c. unstimulated and in response to hand-clapping. Pacoa was maintained at 20 mm Hg. Seizure-like e.e.g. tracings were seen during anaesthesia with the ethers but not with non-ethers. With fithrane, seizure tracings and focal twitching were seen in response to hand-clapping. With divinyl and diethyl ether, spontaneous seizures occurred at deep anaesthesia (2.5—3 m.a.c). With Forane spontaneous spike activity was seen and with methoxyflurane low amplitude deflections superimposed on a flat background followed hand-clapping. With Ethrane, increasing Pa 3 tended to abolish spike and seizure response to hand-clapping. Suxamethonium abolished the muscular twitches but not the e.e.g. seizures with Sthrane
TL;DR: It is postulated that the effect of these drugs is to accelerate decay of the memory trace, thus impairing its consolidation and producing anterograde amnesia.
Abstract: Short-term memory following the intravenous injection of methohexitone (0.15 mg/kg), diazepam (0.05 mg/kg) and sodium 4-hydroxybutyrate (10 mg/kg) has been examined by means of a visually presented digit retention test with intervals of 4 and 20 seconds before recall. No significant change was found with the 4-second interval; statistically significant impairment was found with the 20-second interval. It is postulated that the effect of these drugs is to accelerate decay of the memory trace, thus impairing its consolidation and producing anterograde amnesia. A versatile computerized test of short-term memory is described.
TL;DR: An investigation is described into the problems of dreaming and recall under anaesthesia, using thiopentone for induction and nitrous oxide for the maintenance of anaesthesia and no premedicant or volatile anaesthetic agent being used.
Abstract: An investigation is described into the problems of dreaming and recall under anaesthesia. One hundred and twenty patients were divided into four equal groups. Group 1 were anaesthetized using thiopentone for induction and nitrous oxide for the maintenance of anaesthesia, muscle relaxation being provided by tubocurarine and no premedicant or volatile anaesthetic agent being used. The three other groups received modifications of this technique: group 2 received pre-anaesthetic medication with morphine (1 mg/stone body weight (6.3 kg) 30–60 min before operation); group 3 received small concentrations (0.5–0.3 per cent) of halothane as an adjuvant, and group 4 small concentrations (0.3–0.1 per cent) of methoxyflurane. The incidence of dreaming in association with anaesthesia was high in the case of group 1 (57 per cent) but significantly less in group 2 (23 per cent; P
TL;DR: Measurements of cardiac output and pulmonary venous admixture were obtained at three levels of arterial carbon dioxide tension, suggesting that, in contrast to halothane anaesthesia, myocardial contractility and autonomic reactivity were essentially normal.
Abstract: SUMMARY In six unpremedicated adult female patients during anaesthesia with the anaesthetic agent enflurane (Ethrane), measurements of cardiac output and pulmonary venous admixture were obtained at three levels of arterial carbon dioxide tension (means 18.2, 39.9, and 57.6 mm Hg respectively) during constant volume mechanical ventilation. Cardiac output was well maintained (means 4.70, 5.03, and 7.94 l./min during hypo-carbia, eucarbia, and hypercarbia respectively). The response to carbon dioxide resembled that seen in awake man; suggesting that, in contrast to halothane anaesthesia, myocardial contractility and autonomic reactivity were essentially normal. Pulmonary venous admixture remained constant (means 8.5,8.5, and 8.6 per cent during hypocarbia, eucarbia, and hypercarbia respectively). Changes in the alveolar-arterial oxygen tension difference (mean A-a Po2 diff.: hypocarbia 90; eucarbia 82; and hypercarbia 61 mm Hg) were attributable to increased mixed venous oxygen tension as a result of changes in cardiac output while the oxygen consumption remained constant.
TL;DR: CT1341 is a new intravenous anaesthetic which appears to have overcome the disadvantages of the earlier steroid and duration of action is intermediate between that of the barbiturates and propanidid and postoperative sickness is rare.
Abstract: SUMMARY CT1341 is a new intravenous anaesthetic which appears to have overcome the disadvantages of the earlier steroid. The formulation is a mixture of two closely related steroids with Cremophor EL and the optimum dose for induction is 50–60 μl/kg though much larger doses can be given without serious side effects. As the dose is increased the incidence of muscle movements, respiratory depression and hypotension rises. Duration of action is intermediate between that of the barbiturates and propanidid and postoperative sickness is rare.
TL;DR: Depression of critical flicker frequency has been measured following the intravenous injection of methohexitone, diazepam and sodium 4-hydroxybutyrate and no significant changes occurred after the injection of isotonic saline.
Abstract: Statistically significant depression of critical flicker frequency has been measured following the intravenous injection of methohexitone (0.15 mg/kg), diazepam (0.05 mg/kg) and sodium 4-hydroxybutyrate (10 mg/kg). In the cases of methohexitone and diazepam the maximal measured changes (4.73 per cent and 7.07 per cent, respectively) occurred after 5 minutes and persisted for up to 90 minutes. After 4-hydroxybutyrate, depression was maximal at 15 minutes (4.32 per cent), but had disappeared by 30 minutes. No significant changes occurred after the injection of isotonic saline.
TL;DR: Only a small percentage of the dose of the drugs was recovered by the method used, and more might be accounted for by undetected water-soluble metabolites.
Abstract: SUMMARY The biotransformation and urinary excretion of the local analgesic drug bupivacaine and its homologue mepivacaine have been studied in five healthy male volunteers in whom the urine was maintained at pH 5. Each drug (43.4 mg) was given intravenously to four subjects. Blood samples were taken for 8 hours and urine was collected for 24 hours: both were analyzed by gas-chromatography. A mean of 16 per cent of the mepivacaine given was excreted unchanged, and only 6 per cent of the dose of bupivacaine. The production of the N-dealkylated metabolite of both drugs, pipecolylxylidine (PPX) was confirmed in all subjects. More PPX was excreted after bupivacaine (5.11 per cent of the dose) than after mepivacaine (1.23 per cent). Since, when PPX itself was given to two subjects, almost half was excreted unchanged in the urine, this metabolite could not account for a large proportion of either drug. Only a small percentage of the dose of the drugs was recovered by the method used, and more might be accounted for by undetected water-soluble metabolites. Blood concentrations of bupivacaine fell more rapidly than those of mepivacaine in the first 2 hours, and thereafter they declined at similar rates.
TL;DR: The records of a consecutive series of 920 cases of continuous lumbar epidural analgesia for the control of pain in labour were examined to ascertain the incidence of unilateral block and unblocked segments.
Abstract: SUMMARY The records of a consecutive series of 920 cases of continuous lumbar epidural analgesia for the control of pain in labour were examined to ascertain the incidence of unilateral block and unblocked segments. An unblocked segment was noted to have occurred in 6.7 per cent of patients and was persistent in 1.5 per cent of patients. Unilateral block occurred in 1.5 per cent of patients, being persistent in 0.54 per cent.
TL;DR: It appears that piritramide has a greater hypnotic effect than an equi-analgesic dose of morphine, but that it has a lesser incidence of other side effects, particularly nausea and vomiting, and hypotensive effects.
Abstract: SUMMARY In a double-blind trial three dosage strengths of piritramide, 5, 10 and 20 mg, were compared with morphine 15 mg in the treatment of postoperative pain. Pain intensity was assessed by the patient, and pain relief and side effects by a nurse-assessor. A iog-dose response relationship was established for piritramide. Piritramide 20 mg was shown to be equivalent to morphine 15 mg in analgesic effect. From this and previous studies of piritramide, it appears that piritramide has a greater hypnotic effect than an equi-analgesic dose of morphine, but that it has a lesser incidence of other side effects, particularly nausea and vomiting, and hypotensive effects. Piritramide is indicated as a suitable analgesic for postoperative pain relief.
TL;DR: Manipulation of the laryngoscope during a difficult orotracheal resulted in compression injury of the lingual nerve, which led to Tongue sensation gradually returned after one month.
Abstract: SUMMARY Manipulation of the laryngoscope during a difficult orotracheal resulted in compression injury of the lingual nerve. Tongue sensation gradually returned after one month.