Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of perioperative mental function after general anaesthesia and spinal anaesthesia with intravenous sedation.
This study compared the postoperative mental function in 44 elderly patients following general anaesthesia (GA) or spinal anaesthesia (SA) with sedation for transurethral resection of prostate. The Mini-Mental State (MMS) was done preoperatively and postoperatively at six hours, one day, three days, five days and one month. The geriatric mental status examination was performed preoperatively and one month after the anaesthetic. ⋯ In the GA group, the significant decrease in MMS score occurred at 6 h postoperatively (P less than 0.002) whereas in the SA group with sedation, MMS score also decreased significantly at 6 h (P less than 0.005). In conclusion, there was no significant difference in perioperative mental function between the general and spinal anaesthetic groups when supplemental IV sedation was given. In both groups, perioperative mental function decreased significantly at 6 h postoperatively.
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Case Reports
Failure of a lidocaine test dose to identify subdural placement of an epidural catheter.
We report the failure of a test dose of 3 ml lidocaine 1.5 per cent with 15 micrograms epinephrine to identify subdural placement of an epidural catheter in a parturient. Thirty-five minutes after injection of 13 ml lidocaine 1.5 per cent, intended to provide epidural analgesia, the patient developed an extensive sensory neural blockade. Some motor control was maintained and sympathetic block was incomplete. ⋯ Subdural injections are uncommon and unpredictable in their occurrence. Test doses do not consistently identify misplaced catheters. A negative response to a test dose does not guarantee that extensive neural blockade will not occur during epidural analgesia.
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Case Reports
Histamine 2 receptor blocker in the treatment of protamine related anaphylactoid reactions: two case reports.
Two case reports are described of acute anaphylactoid reactions following the administration of protamine to reverse the anticoagulation effect of heparin in patients undergoing coronary artery bypass graft surgery. The administration of cimetidine seemed to reverse the anaphylactoid reaction after conventional treatment with epinephrine, H1 receptor blocker, and steroids had failed. We recommend that H2 receptor blockade be included with other drugs in the treatment of anaphylactoid reactions following protamine, and possibly after anaphylactoid reactions associated with other substances.
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Randomized Controlled Trial Clinical Trial
Atropine-neostigmine mixture: a dose-response study.
The dose-response relationship and the doses of atropine required to prevent neostigmine from lowering heart rates below baseline in 50 per cent (ED50) and 95 percent (ED95) of patients after antagonism of pancuronium-induced neuromuscular blockade were determined in 70 patients with neostigmine-atropine mixtures. Neostigmine 0.04 mg.kg-1 (group A, n = 35) or 0.06 mg.kg-1 (group B, n = 35) was randomly mixed with one of seven doses of atropine (ranging from 0.014 to 0.04 mg.kg-1) in group A and from 0.02 to 0.04 mg.kg-1 in group B), with dose-response curves for atropine being constructed for both groups 5 and 10 min after injection of the mixture. These dose-response curves were found to be parallel in both groups. ⋯ The estimated ED50 doses of atropine in groups A and B at 5 min were 0.031 and 0.033 mg.kg-1 respectively, and at 10 min the ED50 doses were 0.037 and 0.037 mg.kg-1 respectively. The calculated ED95 doses of atropine in groups A and B at 5 min were 0.05 and 0.046 mg.kg-1, and at 10 min the ED95 doses were also similar, being 0.06 and 0.055 mg.kg-1 respectively. Under the conditions employed in this study it would seem that in order to prevent late reductions in heart rates, the appropriate doses of atropine when used with neostigmine should be greater than that commonly used.
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Case Reports
Complications during anaesthesia in patients with Duchenne's muscular dystrophy (a retrospective study)
The purpose of this retrospective study was to estimate the frequency and severity of anaesthetic complications in patients with Duchenne's muscular dystrophy (DMD). Forty-four boys with DMD were exposed to anaesthesia and surgery 84 times during a period of 22 years (1965-86). The procedures took place at 15 different hospitals. ⋯ Three out of the eight patients with severe complications occurred 1.5, 2.5 and 4 years before the neuromuscular disease was diagnosed. Thus an unusual course of anaesthesia in male children calls for further investigation. Although it has been stated before that succinylcholine is contraindicated in patients with Duchenne's muscular dystrophy, the drug continues to be used.