Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The ABCOM 1 transtracheal Doppler (TTD) has been developed as a non-invasive cardiac output monitor. With this device, cardiac output is continuously calculated from ascending aortic blood flow velocity and aortic diameter obtained via an ultrasound transducer incorporated into the tip of an endotracheal tube. We evaluated the clinical use of the ABCOM 1 monitor and compared cardiac outputs obtained using the TTD system with simultaneous thermodilution (TD) measurements. ⋯ The average difference between measurement techniques and the limits of agreement were unacceptably large (mean difference = 3.04 L.min-1, mean +/- 2 SD = -6.04 to 12.48 L.min-1). Separately analyzing only those measurements during which Doppler signal quality was adequate did not improve agreement between TTD and TD measurements. On the basis of these findings, TTD cannot be recommended as a clinical cardiac output measurement technique.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre Trial.
A multicentre trial was designed to determine the dose-response and side-effects of esmolol when administered as a single iv bolus prior to induction of anaesthesia for controlling the haemodynamic response to tracheal intubation. Five hundred and forty-eight patients from 12 university-affiliated centres across Canada were randomized prospectively to receive either placebo (PLAC) or esmolol (E) in a dose of 100 mg (E100) or 200 mg (E200). Study medication was given immediately before induction of anaesthesia with thiopentone 3-5 mg.kg-1 and succinylcholine 1.5 mg.kg-1. ⋯ Other side-effects, such as bradycardia, bronchospasm or pain on injection, occurred no more frequently in either esmolol group than with placebo. It is concluded that a 100 mg bolus of esmolol is safe and effective for controlling the haemodynamic response to tracheal intubation. This dose of esmolol combined with a low dose of narcotic (fentanyl 2-3 micrograms.kg-1 or equivalent) results in effective control of both heart rate and blood pressure, while avoiding important side-effects.
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Case Reports
Pulmonary hypertension and cardiomyopathy: anaesthetic management for caesarean section.
Pulmonary hypertension in pregnant women is uncommon but is associated with a high mortality. We present the case of a 14-yr-old parturient with pulmonary hypertension and cardiomyopathy who required a Caesarean section. ⋯ The successful use of lumbar epidural anaesthesia with lidocaine and fentanyl is described. When the local anaesthetic was administered slowly and in increments, epidural anaesthesia was safe for both mother and fetus.
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Randomized Controlled Trial Comparative Study Clinical Trial
Brachial plexus block with bupivacaine: effects of added alpha-adrenergic agonists: comparison between clonidine and epinephrine.
The effects of clonidine and epinephrine, administered into the brachial plexus sheath, were evaluated in 60 patients who underwent surgery of the upper limb. All patients received 40 to 50 ml of 0.25% bupivacaine, injected into the brachial plexus sheath, using the supraclavicular technique. The patients were randomly allocated to two groups so that 30 patients received 150 micrograms clonidine hydrochloride (Group I), and 30 received 200 micrograms epinephrine (Group II). ⋯ The block produced with the addition of clonidine was longer (994.2 +/- 34.2 vs 728.3 +/- 35.8 min) and superior to that with epinephrine (P less than 0.001). No major side-effects were recorded. We conclude that the injection of clonidine into the brachial plexus sheath is an attractive alternative to epinephrine to prolong the duration of analgesia following upper limb surgery under conduction anaesthesia.