Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Assessment and accurate replacement of blood loss during primary craniosynostosis repair is difficult due to patient size and surgical technique. Eighty-five charts of all patients undergoing primary craniosynostosis repair over a 15-year period were reviewed to determine blood loss and to assess blood transfusion practices both intraoperatively and postoperatively. Blood loss was calculated on the basis of estimated red cell mass (ERCM). ⋯ Intraoperatively, 70 per cent of all patients were appropriately managed with respect to blood transfusion. Postoperatively only 29 per cent of patients receiving transfusions were transfused appropriately. At our institution, intraoperative blood transfusion practices are appropriate, but postoperative transfusions are frequently unnecessary.
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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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Two cases of cardiac tamponade caused by dissections of the ascending thoracic aorta are described. Despite uneventful induction of anaesthesia one patient exsanguinated following sternotomy and release of pericardial tamponade as the resulting increase in blood pressure caused aortic rupture. ⋯ The anaesthetic management of a patient with cardiac tamponade is directed towards maintaining cardiac filling pressures and contractility. When the tamponade is released the sudden increase in cardiac output and blood pressure may cause the already weakened aorta to rupture.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the incidence of pruritus following epidural opioid administration in the parturient.
Epidural morphine is associated with a high incidence of pruritus when used for pain control in the post-Caesarean section population. The purpose of this study was to compare the incidence of pruritus associated with epidural morphine, fentanyl, buprenorphine and butorphanol. ⋯ This study demonstrated that the incidence of pruritus was significantly higher following the use of epidural morphine and fentanyl. Even though epidural butorphanol and buprenorphine exhibited a low incidence of pruritus, their duration of analgesia was not long enough to make either attractive for single-dose administration.