Canadian journal of anaesthesia = Journal canadien d'anesthésie
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To examine the effects of low-flow cardiopulmonary bypass (CPB) and circulatory arrest (PHCA) on cerebral pressure-flow velocity relationships, we studied 32 patients (< 9 mo of age) undergoing corrective cardiac procedures. Pressure-flow velocity relationships were studied during profound hypothermia (nasopharyngeal temperature < 20 degrees C). Cerebral blood-flow velocity (CBFV) was measured in the middle cerebral artery using transcranial Doppler sonography. ⋯ In 12 of these patients the pattern of recovery of CBFV was the same as that observed after low-flow CPB whereas the remaining five (29%) demonstrated a pattern of recovery identical to the ones recorded after PHCA. We conclude that after PHCA a higher CPP is necessary to re-establish and maintain detectable CBFV. Furthermore, during low-flow CPB, patients where CBFV becomes non-detectable and show a pattern of CBFV recovery similar to PHCA, cessation of cerebral perfusion must be considered.
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We report a case of spinal subdural haematoma with neurological deficit in a 36-yr-old woman following Caesarean section for severe preeclampsia and placental abruption. She had been taking chronic trifluoperazine treatment for depression. Her activated partial thromboplastin time (aPTT) was 49 sec (normal = 26-36) but all other tests of coagulation were normal. ⋯ Seventy-two hours after delivery, she was found to have bilateral leg weakness, urinary incontinence, absent rectal sphincter tone and asymmetrical leg reflexes. The diagnosis of spinal haematoma was confirmed by magnetic resonance imaging. She underwent emergency laminectomy and made a full neurological recovery.
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We reviewed the out-patient consultation notes of 136 pregnant women seen at the Ottawa Civic Hospital from 1985 to 1991 to evaluate the efficacy of an Obstetric Anaesthesia Assessment Clinic (OAC). In addition, their anaesthetic records from labour and delivery were reviewed. For each patient the reason for referral was recorded according to the involved organ system. ⋯ The OAC gave an opportunity for patient education regarding anaesthetic options for labour and delivery. The attending anaesthetist was provided with a risk assessment and anaesthetic management plan which was adhered to with only two exceptions. Finally, the obstetrician was given consistent advice regarding anaesthesia management that may affect obstetrical decisions.
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Biography Historical Article
Harold Griffith Memorial Lecture. The Griffith legacy.
1992 was the anniversary of Crawford Long's use of ether in 1842, and Griffith and Johnson's introduction of Intocostrin into anaesthetic practice in 1942. Harold Randall Griffith was born in Montreal in 1894 and died in 1985. He interrupted his medical studies to serve in the first world war and was awarded the Military Medal for gallantry at the battle of Vimy Ridge. ⋯ He was one of those responsible for inaugurating the World Federation of Societies of Anaesthesiology and was President of the First World Congress of Anaesthesiology in 1955. It is remarkable that the introduction of curare into anaesthetic practice was delayed until 1942, since curare had been used in anaesthesia some 30 years previously. However, it was probably Griffith's confidence in his own clinical abilities which enabled him to seize the opportunity when it was offered.
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Randomized Controlled Trial Clinical Trial
Perioperative gastric aspiration increases postoperative nausea and vomiting in outpatients.
The efficacy of aspiration of gastric contents to reduce postoperative nausea and vomiting was investigated in a controlled randomized, double-blind study of 265 outpatients. Patients in the treated group had their stomachs aspirated with an orogastric tube. In the control group no tube was inserted. ⋯ It was also comparable in the recovery room and the day surgery unit. However, treated patients had a higher incidence of both nausea (26.5% vs 12.0%, P < 0.005) and vomiting (16.7% vs 6.8%, P < 0.02) after their discharge from the day surgery unit. We conclude that aspiration of gastric contents with an orogastric tube does not decrease postoperative nausea and vomiting in outpatients and may increase it after discharge of the patient.