Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Anaesthesia for a patient with central alveolar hypoventilation syndrome (Ondine's Curse).
The perioperative anaesthetic management of an adult patient with central alveolar hypoventilation syndrome (CAHS), Ondine's Curse, is described for anterior resection of a carcinoma of the bowel. This rare syndrome results in alveolar hypoventilation, hypercarbia, hypoxaemia with secondary polycythaemia, pulmonary artery hypertension, and cor pulmonale. ⋯ However, postoperative mechanical ventilation was required until recovery of the respiratory drive, which was ablated by anaesthetic drugs, epidural morphine and high inspired oxygen concentrations. The pathophysiology and treatment of this syndrome are reviewed.
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Surgical patients often are receiving antiarrhythmic therapy. Thus, because anaesthetic agents can affect cardiac function and may interact with concurrent antiarrhythmic medications, the anaesthetist should be aware of the electrophysiology associated with dysrhythmias and their management. ⋯ In addition, unexpected untoward reactions and toxicity can result from interactions of anaesthetic agents and these drugs. This review discusses normal cardiac electrophysiology, common dysrhythmias and the electrophysiological effects of the newer oral antiarrhythmic drugs.
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Randomized Controlled Trial Clinical Trial
Esmolol bolus and infusion attenuates increases in blood pressure and heart rate during electro-convulsive therapy.
To determine whether a standardized dose of esmolol can effectively attenuate the cardiovascular response to electroconvulsive therapy (ECT), 17 ASA physical status I-II patients were studied in a randomized within-patient, crossover design. Each patient received "no esmolol" during one ECT and three to five days later crossed over to the alternative treatment receiving an esmolol 80 mg bolus followed by 24 mg · min-1 infusion two minutes prior to induction of anaesthesia and continued for five minutes after induction. Esmolol blunted the maximum increases in heart rate (HR) by 26 per cent, mean arterial pressure (MAP) by 14 per cent, and rate pressure product by 37 per cent with significant differences (P < 0.05) noted at one, two, three and four minutes after ECT (minutes five, six, seven, and eight of the esmolol infusion). There was no significant difference in seizure duration between the two groups and no adverse reactions occurred.
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The sensitivity of the masseter to atracurium was measured in ten children aged 3-10 yr undergoing elective surgery, and compared with that of the adductor pollicis. During nitrous oxide-halothane anaesthesia and mechanical ventilation, supramaximal nerve stimulation was applied to the ulnar nerve at the elbow and to the nerve to the masseter, at a point inferior to the zygomatic arch, anterior to the mandibular condyle. Jaw closure was measured by a force displacement transducer system attached to an oral airway and connected to a metal frame fixed to the operating table 10 cm caudad to the chin. ⋯ However, this relationship was not constant in every patient, and in some patients the masseter was much more sensitive than the adductor pollicis. The time from injection of the first dose of atracurium to maximum blockade was 2.5 +/- 0.2 min at the masseter and 3.2 +/- 0.2 min at the adductor pollicis (P less than 0.05). It is concluded that when atracurium is administered to paediatric patients, neuromuscular blockade is usually of the same intensity at each muscle but occurs sooner at the masseter than at the adductor pollicis.(ABSTRACT TRUNCATED AT 250 WORDS)