Canadian journal of anaesthesia = Journal canadien d'anesthésie
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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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Randomized Controlled Trial Clinical Trial
Large volumes of apple juice preoperatively do not affect gastric pH and volume in children.
The effect on gastric pH and volume of 0, 6 and 10 ml.kg-1, of apple juice given 2.5 hours before surgery to children aged five to ten years was investigated in this prospective, randomized, single-blind study. Gastric contents were aspirated after induction of anaesthesia, and the volume measured. The pH of the gastric aspirate was then assessed using pH paper. ⋯ Gastric volumes after 0, 6 and 10 ml.kg-1, of juice averaged (mean +/- SD) 0.45 +/- 0.31, 0.66 +/- 0.79 and 0.71 +/- 0.76 ml.kg-1, respectively; gastric pH averaged 1.7 +/- 0.6, 1.7 +/- 0.6 and 1.8 +/- 0.8, respectively. On the basis of questions asked immediately before induction of anaesthesia, patients who drank 6 ml.kg-1 of apple juice had decreased thirst and were less irritable and upset before anaesthesia than those who had not (P less than 0.05). It is concluded that drinking large volumes of clear apple juice 2.5 hours before scheduled surgery does not have a measurable effect on gastric volume and pH and may offer benefits such as improved patient comfort.
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Randomized Controlled Trial Clinical Trial
Dose-related effects of succinylcholine on the adductor pollicis and masseter muscles in children.
This study was performed to determine the effects of various doses of succinylcholine on resting tension and evoked twitch height at the masseter and adductor pollicis muscles in children. Twenty patients, aged 3-10 yr, ASA physical status I or II, were randomly assigned to receive succinylcholine 0.15, 0.25, 0.50 or 1.00 mg.kg-1, during halothane-nitrous oxide anaesthesia. Supramaximal train-of-four stimulation was applied simultaneously to the ulnar nerve and the nerve to the masseter. ⋯ A dose-related increase in resting tension was observed in both muscles, but its magnitude was five times greater at the masseter. With succinylcholine, 1 mg.kg-1, this increase was 51.6 +/- 16.8 g at the masseter and 9.1 +/- 2.3 g at the adductor pollicis. Tension returned to baseline within 1-2 min.(ABSTRACT TRUNCATED AT 250 WORDS)
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The increases in tension at the masseter and adductor pollicis muscles following succinylcholine, 1 mg · kg-1, during halothane anaesthesia were measured in eight children, 3-10 yr, with strabismus. The results were compared with those obtained in a control group of general surgical patients. Supramaximal train-of-four (TOF) stimulation was applied to the ulnar nerve and the nerve to the masseter simultaneously. ⋯ The duration of the phenomenon was 1-2 min in both muscles studied, and was not statistically different in the strabismus group. Time to complete neuromuscular blockade was significantly faster at the masseter, 31 ±6 sec -control groups; 39 ±11 sec -strabismus group, than at adductor pollicis, 61 ±34 sec -control groups; 75 ±28 sec -strabismus group (P < 0.05 and 0.013 respectively). It is concluded that succinylcholine causes similar increases in jaw tension and comparable degrees of neuromuscular blockade in patients undergoing strabismus surgery as in other children.
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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.