Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Patient-controlled analgesia (PCA) using fentanyl in a parturient with a platelet function abnormality.
A term parturient with documented platelet dysfunction presented to the case room for induction of labour. Since this bleeding abnormality contraindicated the use of lumbar epidural analgesia (LEA), we elected to use an iv fentanyl patient-controlled analgesia (PCA) technique for pain relief during labour. ⋯ Mother and neonate tolerated the fentanyl without sequelae. If facilities to monitor the neonate and mother are present, this method of analgesia is useful in those patients where LEA is contraindicated.
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Sunnybrook Health Science Centre is an adult regional trauma unit serving metropolitan Toronto and environs. We undertook a two-year retrospective review of patients admitted to our institution with blunt thoracic trauma. Three hundred and thirty-three patients with blunt trauma and an injury severity score (ISS) greater than 17 required emergency surgery. ⋯ Awake intubation was undertaken in 77.5% of patients requiring anaesthesia and surgery because of the potentially compromised airways and difficult intubations due to the nature of the associated injuries. Finally, 74% of patients undergoing urgent surgery required mechanical postoperative ventilation. The presence of blunt chest trauma should be considered a marker of the severity of injury sustained by the patient.