Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Magnesium plays an important role as a cofactor in many of the body's critical functions and reactions. A deficiency or excess of extracellular magnesium can produce significant signs and symptoms. Hypomagnesaemia is a common finding in hospitalised patients, especially those in critical care areas. ⋯ Hypermagnesaemia is often iatrogenic and is more likely in patients with renal dysfunction who are receiving oral or parenteral magnesium. The specific antidote is intravenous calcium. Anaesthetised patients with high serum magnesium levels are at risk from hypotension, potentiation of non-depolarising neuromuscular blockers, postoperative respiratory failure and cardiac arrest.
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Randomized Controlled Trial Clinical Trial
Reversal of epidural morphine-induced respiratory depression and pruritus with nalbuphine.
The effect of nalbuphine on the respiratory depression, pruritus and analgesia induced by epidural morphine was determined in a randomized, prospective, double-blind, placebo-controlled fashion. Twenty ASA physical status I women received 0.1 mg.kg-1 epidural morphine at induction of general anaesthesia for elective total abdominal hysterectomy. Group 1 (n = 14) received 0.3 mg.kg-1 nalbuphine intravenously six hours after the epidural morphine administration. ⋯ Nine of the 14 patients receiving nalbuphine appeared to become more sedated, despite an improvement in ventilation. Pruritus was antagonized by 0.1 mg.kg-1 nalbuphine (p less than 0.006). There was no reversal of analgesia after administration of 0.3 mg.kg-1 nalbuphine.
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A 24-year-old black female presented for repeat elective Caesarean section. The procedure was performed under epidural anaesthesia. Sufentanil 25 micrograms, intended for postoperative analgesia, was inadvertently diluted to 10 ml with 15 per cent potassium chloride (KCl) instead of preservative-free normal saline (0.9 per cent NaCl). ⋯ Dexamethasone 10 mg was administered intravenously to reduce spinal cord oedema. Intravenous diazepam 10 mg and meperidine 75 mg were given for sedation and analgesia. Complete recovery occurred within 12 hours.
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We report the case of a 38-year-old eclamptic patient undergoing emergency Caesarean section who required awake nasotracheal intubation because of her massively swollen and lacerated tongue. Vasoconstriction, in addition to topical anaesthesia, was required due to thrombocytopaenia. The use of three per cent lidocaine with 0.125 per cent phenylephrine for anaesthesia and vasoconstriction is described with successful maternal and neonatal outcome.