Canadian journal of anaesthesia = Journal canadien d'anesthésie
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In an attempt to define what factors are important to the development of postanaesthetic complications, the data from a nine-year prospective study of anaesthetic practice in a large tertiary care institution were evaluated. A model of anaesthetic morbidity dependent upon factors of patient illness, surgical practice, anaesthetic technique and physician experience, and duration of anaesthesia was developed. Postoperative anaesthetic morbidity was defined as any anaesthetic-related complication which, in the opinion of the follow-up nurse, was associated with prolonged hospitalization or documented compromise of the patient. ⋯ The duration of anaesthetic exposure was an important determinant of risk (odds ratio = 2.53), with complications increasing with the length of anaesthetic time. As to factors under control of the anaesthetist those patients experiencing operating room complications (odds ratio = 3.36) or those receiving pure spinal (odds ratio = 5.53) or narcotic techniques (odds ratio = 2.14) had higher risks of postoperative complications. Finally, it would appear that the greater the experience of the anaesthetist the less the risk of postoperative problems (odds ratio = 0.52).
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The use of atracurium during anaesthesia for abdominal hysterectomy in a 37-year-old patient with homozygous plasma cholinesterase [EsEs] deficiency is described. Intubation was achieved utilizing 0.47 mg X kg-1 of atracurium. ⋯ The duration of action of the drug was not different from that described in normal patients. Atracurium would appear to be a safe drug to provide neuromuscular relaxation in patients with plasma cholinesterase deficiency, where surgical procedures of intermediate duration are being undertaken.
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The background, organization, problems, and successful implementation of an anaesthesia training program in Nepal are described. Nepali physicians had previously taken their postgraduate anaesthesia training in western countries, especially in Britain. The low pay of anaesthetists, poor maintenance of equipment, and irregular supplies of anaesthetic drugs in their own country has led many of them to stay abroad. ⋯ An alternative approach to training is presented in which a series of Canadian anaesthetists, over a three-year period, are supporting the establishment of a one-year Diploma in Anaesthesiology program in Nepal. They are working with Nepali anaesthetists and the Institute of Medicine in Kathmandu, Nepal. The local anaesthetists supervise most of the clinical training while the Canadians give academic leadership and guidance.
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Lidocaine 0.5 per cent in a dose of 2 mg X kg-1 was used for intravenous regional analgesia with the tourniquet cuff placed over the forearm. The level of tourniquet cuff pressure employed was the arterial "occlusion pressure" plus 50 mmHg. ⋯ No toxic symptoms and signs were observed. Measurement of serum lidocaine concentrations in 12 patients confirmed the safety of the technique, although small leakage of lidocaine past the inflated forearm tourniquet was detected in some patients.
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The case of a woman with sickle cell trait who sustained a cardiac arrest and died during a Caesarian section under general anaesthesia is reported. Because the common causes of intraoperative hypoxia and shock were ruled out in this case, we believe that death was due to severe concealed aorto-caval compression. ⋯ We emphasize that while complications secondary to sickle cell trait during general anaesthesia are very rare, they can occur. We discuss methods of monitoring such patients.