Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
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.
-
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.
-
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.
-
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.
-
A sixty-eight-year-old female developed severe hypotension immediately after the administration of epidural meperidine for post-thoracotomy pain. Two preceding injections of epidural opiates had been uneventful. The cardiovascular collapse was difficult to reverse and may have contributed to the patient's subsequent death. Cardiovascular complications have not been reported frequently as a possible side effect of epidural opiate analgesia.