Canadian journal of anaesthesia = Journal canadien d'anesthésie
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A formal on-site survey of all anaesthetizing locations in the Province of Manitoba was initiated in the Spring of 1988. Serious deficiencies of anaesthetic equipment previously noted on random survey were confirmed. Recognizing a need for improved standards for delivery of anaesthetic services through safe, functional anaesthetic equipment, the province undertook to fund the upgrading of all anaesthetic gas delivery systems under its jurisdiction. ⋯ After careful assessment 92 machines were replaced, 66 machines were upgraded and 45 machines were deleted from further service. Although the maintenance and upgrading of medical equipment is the individual health care facility's responsibility, substantial benefit was recognized by a provincial approach. The authors recommend a similar approach for other Canadian provinces.
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A prospective study was undertaken to determine the cardiovascular response of a continuous alfentanil infusion during abdominal aortic surgery (AAS). Each subject (n = 20) received a beta-blocking drug preoperatively, and was premedicated with oral lorazepam. Anaesthesia was induced with alfentanil 50 micrograms.kg-1 and thiopentone 3 mg.kg-1, and was maintained with a variable rate infusion of alfentanil and 66 per cent nitrous oxide in oxygen. ⋯ However, there was a 33 per cent incidence of myocardial ischaemia on the first postoperative day. There were no myocardial infarcts and no deaths. We conclude that in beta-blocked patients undergoing aortic reconstructive surgery, a variable rate alfentanil infusion administered with 66 per cent nitrous oxide provides anaesthesia characterized by good haemodynamic control without the need for supplemental agents or vasoactive drugs.