Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Atypical malignant hyperthermia with persistent hyperkalaemia during renal transplantation.
A 35-year-old 110 kg male developed marked hyperkalaemia, hyponatraemia, hypercapnia and hyperthermia during living-related renal transplantation under anaesthesia with oxygen-nitrous oxide, isoflurane and muscle relaxation with atracurium. This is the first report of successfully treated malignant hyperthermia triggered by isoflurane during renal transplantation with early appearance and persistent (to 12 hours after surgery) electrolyte abnormalities.
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The perioperative records of 354 consecutive patients undergoing craniotomy for surgical treatment of intractable epilepsy performed with conscious-sedation analgesia were reviewed retrospectively. There was no perioperative morbidity or mortality identified which could be attributed to the anaesthetic technique. ⋯ Less frequent problems included excessive sedation (three per cent), "tight brain" (1.4 per cent) and local anaesthetic toxicity (two per cent). This study confirms that conscious-sedation analgesia provides suitable conditions for craniotomies when brain mapping is required.
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Randomized Controlled Trial Clinical Trial
The effect of preoperative oral droperidol on the incidence of postoperative emesis after paediatric strabismus surgery.
Most children vomit after strabismus surgery. Administration of intravenous droperidol to unpremedicated paediatric patients following induction but prior to eye manipulation markedly reduces the incidence of postoperative emesis. This study tested the hypothesis that even earlier administration of droperidol, orally as a component of an oral premedication, would further reduce the incidence of postoperative emesis in this group of patients. ⋯ One group received the standard oral premedication used for all outpatients at our institution (meperidine 1.5 mg.kg-1, diazepam 0.15 mg.kg-1, atropine 0.02 mg.kg-1). In the other two groups, droperidol in a dose of 50 or 75 micrograms.kg-1 was substituted for the diazepam. Droperidol-treated groups demonstrated a significantly lower incidence of vomiting prior to hospital discharge compared to the groups that received the standard oral premedication (standard--73 per cent, 50 micrograms.kg-1 droperidol--33 per cent, 75 micrograms.kg-1 droperidol--36 per cent) without prolonging hospital stay.
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The case of a 32-year-old parturient with a quintuplet pregnancy is described. The pregnancy had been complicated by premature labour which was treated with ritodrine tocolysis. Betamethasone was administered to hasten fetal lung maturation. ⋯ Low pressure mask-bag ventilation was utilized to maintain oxygen saturation and the patient was intubated and ventilated with positive end-expiratory pressure. Positive pressure ventilation was continued for 24 hours postoperatively. The perioperative course is reviewed and followed by a discussion of the anaesthetic considerations for multiple gestation pregnancies.
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The use of dantrolene to reverse severe unexplained postanaesthetic muscle rigidity in a previously "healthy" 13-year-old male is described. Anaesthesia was induced with thiopentone. After intubation with pancuronium, the patient had an entirely uneventful nitrous oxide, oxygen and halothane anaesthetic. ⋯ The symptoms responded to IV dantrolene in a total dose of 2.0 mg.kg-1. Further testing failed to establish a definite diagnosis. Dantrolene could be a useful drug in treating such unexplained muscle rigidity.