Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Rational transfusion practices are determined by clinical evaluation and utilization of appropriate laboratory tests. While the trend toward more conservative transfusion practices is laudable, blood transfusions should not be withheld because of fear of transfusion-transmitted disease. The blood supply is safer than ever before and advances in monitoring and laboratory testing are facilitating scientific approaches to blood administration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of epidural and patient-controlled intravenous morphine following joint replacement surgery.
The authors conducted a randomized, prospective study comparing epidural morphine with patient-controlled intravenous (iv) morphine in 30 patients recovering from total hip or total knee arthroplasty. Six, 18, and 24 hr postoperatively, patients used a 10 cm visual-analogue scale to indicate both their current degree of discomfort and the maximum discomfort they had experienced since the previous evaluation. Pain at the time of evaluation did not differ between patients receiving epidural (2.6 +/- 0.4 cm, mean +/- SEM) and patient-controlled iv morphine (3.4 +/- 0.3 cm). ⋯ Patients receiving epidural morphine were more likely to require treatment for pruritus (4 of 15) than patients who received patient-controlled iv morphine (none of 15, P less than 0.05). Minimum respiratory rates were lower in patients receiving epidural morphine (15.0 +/- 0.3) than in those receiving patient-controlled analgesia (16.5 +/- 0.4, P less than 0.05), but no patients required treatment for respiratory depression. The authors conclude that epidural morphine may provide more consistent analgesia following joint replacement surgery than patient-controlled morphine; however, there is a higher incidence of side-effects with the epidural technique.
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Infantile pyloric stenosis is the most frequently encountered infant gastrointestinal obstruction in most general hospitals. Although the primary therapy for pyloric stenosis is surgical, it is essential to realize that pyloric stenosis is a medical and not a surgical emergency. Preoperative preparation is the primary factor contributing to the low perioperative complication rates and the necessity to recognize fluid and electrolyte imbalance is the key to successful anaesthetic management. ⋯ Surgical correction was undertaken at an average age of 5.6 wk, and the average weight of the infants at the time of surgery was 4 kg. A clinical diagnosis of pyloric stenosis by history and physical examination alone was made in 73% of the infants presenting to The Hospital for Sick Children. All the infants received general anaesthesia for the surgical procedure and there were no perioperative deaths.
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In patients with congestive heart failure, the release of atrial natriuretic peptide (ANP) is decreased. This study sought to determine the extent of ANP, sympathetic and haemodynamic responses to acutely increased atrial pressure in patients with cardiomyopathies undergoing orthotopic cardiac transplantation. Haemodynamic variables, plasma ANP, norepinephrine, and epinephrine concentrations were measured in 17 patients at five times before and after induction of anaesthesia using either ketamine 1.5 micrograms.kg-1 or sufentanil 3.6 +/- 0.3 micrograms.kg-1. ⋯ There were no differences in epinephrine concentrations in either group. Despite the anticipated haemodynamic and catecholamine differences found between the ketamine and sufentanil groups, the levels of plasma ANP were similar. Based upon these results, it is concluded that ANP exerts little influence in the control of fluid volume or blood pressure in patients with refractory cardiomyopathy.
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To ascertain the anaesthetic complications requiring post-anaesthetic respiratory support in a large obstetrical hospital, the hospital records of obstetrical patients admitted to an adjacent general intensive care unit (ICU) were studied. Obstetrical patients who required mechanical ventilation following anaesthetic complications were identified and their hospital records reviewed. In a ten-year period there were 61,435 women delivered at the Mater Mothers Hospital (MMH) in Brisbane, Queensland, Australia. ⋯ Complications included anaphylaxis, high block and failure of tracheal intubation. The incidence of a major complication of a GA causing admission to the ICU was 1 in 932 and for RA was 1 in 4177 when these were given for delivery (P less than 0.01). If a complication requiring ICU admission and mechanical ventilation is used as the criterion of safety it appears that RA is safer than a GA for delivery.