Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
The purpose of this study was to assess the cumulative incidence of substance use among anesthesiologists during training and practice, the effect of stress on drug use, and deterrent efficacy of institutional prevention programmes. The 260 anesthesiologists who had trained at the Medical College of Wisconsin between 1958-1988 were surveyed by mail regarding psychoactive substance use. Analysis of 183 responses focused on demographic and psychosocial factors. ⋯ Younger respondents (born after 1951) were more critical of drug control programmes than their older cohort. Incidents of substance abuse were reported for both residents and faculty. Psychoactive substance abuse remains a serious problem among anesthesiologists.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Oral midazolam premedication for children with congenital cyanotic heart disease undergoing cardiac surgery: a comparative study.
To determine whether oral midazolam is a safe and effective alternative to our current standard premedication for children with cyanotic congenital heart disease (CCHD), 30 children aged 1-6 yr, scheduled for elective cardiac surgery, were studied. The children were randomly assigned to one of two groups: Group I received oral midazolam 0.75 mg.kg-1 30 min before separation from their parents in the surgical waiting area, and Group II received oral or rectal pentobarbitone 2 mg.kg-1 at 90 min, and morphine 0.2 mg.kg-1 and atropine 0.02 mg.kg-1 im at 60 min before separation. ⋯ Intramuscular injection of morphine produced a transient decrease in mean SpO2 (from 84% to 76%) (P < 0.05) that did not occur after ingestion of oral midazolam. The results of this study indicate that oral midazolam is a safe and effective replacement for the standard premedication for children with CCHD undergoing cardiac surgery and avoids the decrease in SpO2 associated with im injections.
-
Randomized Controlled Trial Clinical Trial
Posture and the spread of hyperbaric bupivacaine in parturients using the combined spinal epidural technique.
This study was undertaken to analyze the effect of posture on the spread of hyperbaric bupivacaine in pregnant women using a combined spinal extradural technique, and to assess the quality of analgesia provided by 10 mg bupivacaine when using this technique. Fifty parturients undergoing elective Caesarean section under regional anaesthesia were randomly allocated to receive 2.0 ml hyperbaric bupivacaine 0.5% in either the sitting or left lateral position. Spinal injection was performed with a 27 gauge, 120 mm long spinal needle using a single space combined spinal extradural technique. ⋯ There was no difference between the two groups in neonatal outcome. Overall, the position of the patient during induction of spinal anaesthesia does influence the rate of onset of analgesia and motor blockade. Injection of 10 mg hyperbaric bupivacaine in the sitting position would not provide adequate analgesia for Caesarean section when using a single space combined spinal extradural technique.
-
Case Reports
Severe respiratory depression after epidural morphine in a patient with myotonic dystrophy.
We describe a patient with myotonic dystrophy who underwent cholecystectomy, and developed severe respiratory depression following epidural administration of morphine to provide postoperative analgesia. At preoperative assessment, he demonstrated near normal vital capacity and maximal voluntary ventilation, but the presence of chronic ventilatory failure with a resting value of PaCO2 51 mmHg. ⋯ Intravenous naloxone resulted in transient improvement in minute volume, suggesting that epidural morphine was responsible for the depression. Epidural morphine can cause unexpected respiratory depression, even at a small dose, because of the sensitivity of the respiratory centre to morphine in patients with myotonic dystrophy.