Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Anaesthetic management of emergency caesarean section followed by pulmonary embolectomy.
This report discusses the anaesthetic management of a patient undergoing emergency Caesarean section followed by an open pulmonary embolectomy with cardiopulmonary bypass. This case was complicated by the major physiological alterations associated with pregnancy and delivery, massive blood loss, cardiac dysrhythmias, hypotension, and cardiac arrest. Both patients, mother and child, made a full recovery.
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Difficult or failed tracheal intubation is an important cause of anaesthetic-related maternal morbidity and mortality. The incidence of failed intubation in parturients is estimated to be as frequent as 1 in 500; that of mortality is unknown, although some 10-13 pregnant women in England, Scotland and Wales die each year because of anaesthetic-related complications. ⋯ Furthermore, adequate assistance, correct use of cricoid pressure, and confirmation of tracheal intubation are fundamental to safe practice. Lastly, should the anaesthetist fail to intubate the patient's trachea, a management protocol is suggested.
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Comparative Study
Neuromuscular and cardiovascular effects of mivacurium chloride in surgical patients receiving nitrous oxide-narcotic or nitrous oxide-isoflurane anaesthesia.
The neuromuscular and cardiovascular effects of mivacurium chloride were studied during nitrous oxide-oxygen narcotic (fentanyl) (n = 90) and nitrous oxide-oxygen isoflurane (ISO) anaesthesia (n = 45). In addition, a separate group (n = 9) received succinylcholine during fentanyl anaesthesia to compare its neuromuscular effects with mivacurium. Mivacurium was initially administered as a single bolus in doses from 0.03 mg.kg-1 to 0.25 mg.kg-1 to study the dose-response relationships, as well as the cardiovascular effects of mivacurium. ⋯ There was minimal change in mean arterial pressure (MAP) or heart rate (HR) following bolus doses of mivacurium up to 0.15 mg.kg-1. Bolus administration of 0.20 mg.kg-1 or 0.25 mg.kg-1 of mivacurium decreased MAP from 78.2 +/- 2.5 to 64.0 +/- 3.2 mmHg (range 12-59 per cent of control) (P less than 0.05). The same doses when administered slowly over 30 sec produced minimal change in MAP or HR.
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Case Reports
Computerized axial tomo-epidurographic and radiographic documentation of unilateral epidural analgesia.
A 23-year-old primigravid patient who received epidural analgesia for pain of labour presented with persistent, apparently irremediable, unilateral analgesia. Computerized axial tomo-epidurography demonstrated absence of circumferential spread due to lateral placement of the catheter. Transforaminal escape of contrast medium into the paravertebral area had occurred and anterior and posterior midline partitioning of the epidural space was obvious. All the usual measures to promote contralateral analgesia, except re-insertion of the catheter, had been tried without success.