Canadian journal of anaesthesia = Journal canadien d'anesthésie
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This study in dogs determined the effect of systemic cooling and arterial hypocarbia during cardiopulmonary bypass (CPB) on the requirements for enflurane anaesthesia (MAC) before and after CPB. Twelve mongrel dogs were each anaesthetized with enflurane in oxygen on two separate occasions. End-tidal enflurane concentration was measured with a Puritan-Bennett Anaesthesia Agent Monitor. ⋯ Analysis of the data, using ANOVA for repeated measures, revealed MAC 3 (1.95 +/- 0.33%, post-CPB) to be reduced when compared with MAC 1 (2.18 +/- 0.28%, P < 0.01) or MAC 2 (2.10 +/- 0.22%, P < 0.01), determined before CPB. Multivariate repeated measures analysis revealed no independent effects of hypothermia or arterial hypocarbia during CPB, on MAC reduction. By the time of the second experiment in each dog (two weeks later), MAC had returned to baseline levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cocaine use, frequently associated with other substance abuse, is becoming more common in the pregnant patient. These patients are more likely to experience peripartum complications. A case of hypertension and pulmonary oedema in such a patient, possibly triggered by ketamine, is reported. ⋯ A number of factors supported a diagnosis of barbiturate withdrawal in this patient, its onset also was related temporally to ketamine administration. Hypertension should be considered a sign of acute barbiturate withdrawal. If a history of cocaine use, particularly crack cocaine, is elicited, one should suspect multiple substance abuse and be especially cautious when administering ketamine.
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Randomized Controlled Trial Clinical Trial
pH adjustment of mepivacaine decreases the incidence of tourniquet pain during axillary brachial plexus anaesthesia.
The effect of pH adjustment of mepivacaine on the incidence of tourniquet pain during axillary brachial plexus anaesthesia was studied. Thirty-nine patients scheduled for hand surgery, during which use of pneumatic tourniquet for longer than 60 min was planned, were randomized into two groups. Both received axillary brachial plexus block with 40 ml, 1.4% mepivacaine, 1:200,000 epinephrine. ⋯ Tourniquet; pain was defined as poorly localized and distinct from an inadequate axillary block by a blinded observer. More tourniquet pain occurred in the control group. The authors conclude that alkalinization of mepivacaine for axillary brachial plexus anaesthesia may be indicated in cases where use of pneumatic tourniquet for long periods is planned.