Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Successful epidural anaesthesia for a patient with Takayasu's arteritis presenting for caesarean section.
The management of a 24-yr-old parturient with Takayasu's arteritis (TA) presenting at term for Caesarean section is discussed. The best anaesthetic management for the patient with TA is controversial, but avoiding regional anaesthesia has been suggested by some authors because of the risk of hypotension and the subsequent need for vasopressors. We report the use of regional anaesthesia in a term parturient with severe TA undergoing Caesarean section. ⋯ The initial doses of 60 mg and 150 mg were followed by a decrease in BP (from 110/70 to 70/40) which was corrected with iv fluids and ephedrine 25 mg. Additional doses of chloroprocaine, 150 and 90 mg, were uneventful. It is concluded that an epidural can be made in safety to provide anaesthesia for Caesarean section in patients with TA.
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The purpose of this study was to determine the halothane concentration in N2O required to block the cardiovascular responses to skin incision (MAC CVR) in infants and children. We studied 64 unpremedicated ASA 1 infants and children (one month to seven years). In each infant or child, anaesthesia was induced slowly with halothane and N2O, and an endotracheal tube was placed. ⋯ The changes of MAP were correlated with changes of both HR and pupillary diameter. These results indicate that the values of MAC CVR50 of halothane in infants and children are higher than those required to block motor responses (MAC). The halothane requirement to block cardiovascular responses is lowest in the children aged one to three years.
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A 76-yr-old man underwent carinal resection for squamous cell carcinoma through the right posterolateral thoracotomy approach. Ventilation was maintained by the use of two high-frequency jet ventilators, each attached to a separate catheter during the time of resection and reconstruction of the tracheal carina. ⋯ During two-lung jet ventilation there was good oxygenation, normocapnia and no cardiovascular complications. The principle advantage of using two separate high-frequency ventilators is that it allows for maximum ventilatory efficiency with lungs of different compliance.