Canadian journal of anaesthesia = Journal canadien d'anesthésie
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This retrospective chart review of 155 patients having coronary artery bypass graft surgery (CABG) over a two-month period determined whether the use of a cell saver apparatus (CSA) (1) reduced or increased the requirements for homologous blood; (2) increased the incidence of post-surgical bleeding; (3) was cost-effective. Two groups of patients were identified. Group 1 (n = 99) received both CSA processed red blood cells and homologous blood components. ⋯ More patients in Group 1 had no transfusion requirements (45 vs 8; P less than 0.05) and there was no increased risk of major haemorrhage. When the capital costs are included, utilization of the CSA was not cost-effective. We conclude that utilisation of a CSA was safe, with no increased risk of bleeding, reduced requirements for homologous blood transfusions, but added to the cost of the procedure.
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Case Reports
Alfentanil for urgent caesarean section in a patient with severe mitral stenosis and pulmonary hypertension.
We present the case of a parturient with severe mitral stenosis and pulmonary hypertension who received general anaesthesia using alfentanil for urgent Caesarean section. Alfentanil promoted haemodynamic stability and allowed immediate postoperative extubation. ⋯ A disadvantage of this technique, neonatal respiratory depression, was promptly reversed with a single dose of naloxone. The anaesthetic management of mitral stenosis in pregnancy is discussed and the neonatal pharmacokinetics of maternally administered alfentanil are presented.
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Ketamine was used as the sole anaesthetic during the induction-to-delivery interval in 20 full-term patients undergoing elective Caesarean section. The intravenous administration of ketamine 1.5 mg.kg-1 was followed by succinylcholine 1.5 mg.kg-1 and tracheal intubation. The mother's lungs were then ventilated using 100 per cent oxygen until the baby was delivered. ⋯ The isolated arm test was negative in all patients having an I-D interval less than 10 min, and was positive in three patients when the I-D interval exceeded ten minutes. The newborns of group A showed higher Apgar scores at one minute, as well as higher umbilical vein PO2 than was achieved in Group B. It was concluded that the technique used was not associated with maternal awareness or neonatal depression, provided that the I-D interval was less than 10 min and the U-D interval was less than 90 sec.