Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural sufentanil does not attenuate the central haemodynamic effects of caesarean section performed under epidural anaesthesia.
The effect of sufentanil 30 micrograms added to the epidural local anaesthetic solutions used for anaesthesia during elective Caesarean section on central haemodynamic variables was studied. Haemodynamic measurements made by thoracic electrical bioimpedance (TEB) monitoring were compared in 21 healthy parturients undergoing Caesarean section under epidural anaesthesia with and without the addition of epidural sufentanil. The patients were randomized to control (Group C) and study (Group S) groups. ⋯ Cardiac index was increased throughout the intraoperative period in Group S but was less frequently elevated in Group C. Ejection fraction was increased throughout the perioperative period in Group S but not in Group C. End-diastolic index increased following iv preloading in both groups and returned to baseline with induction of epidural block.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Anaesthetic management of a neonate with prenatally diagnosed cervical tumour and upper airway obstruction.
We report the anaesthetic management of a mother, and airway management of a neonate with a prenatal diagnosis of cervical cystic hygroma causing upper airway obstruction. The mortality of such neonates due to upper airway obstruction is reported to exceed 20% following deliveries. Elective Caesarean section was performed under general anaesthesia, and in utero tracheal intubation of the neonate was accomplished under uninterrupted maternal-fetal circulation. ⋯ We believe that it is important that a multidisciplinary approach be initiated for planning of airway management of the neonate soon after the diagnosis is made. Laryngoscopy blades larger than normal for neonates, and a portable Doppler to monitor the viability of the neonate were found to be useful in the management of the neonate during in utero tracheal intubation. Although estimated blood loss was not increased, nor did uterine atony occur postoperatively despite the use of ritodrine during Caesarean section, the efficacy and safety of ritodrine to delay placental detachment have not been proved.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral premedication for paediatric ambulatory anaesthesia: a comparison of midazolam and ketamine.
To compare the clinical characteristics of two oral premedicants, midazolam and ketamine, 40 healthy children, one to six years of age, who were scheduled for ambulatory dental surgery, were assigned to receive either oral midazolam 0.5 mg.kg-1 or oral ketamine 5.0 mg.kg-1 in a double-blind, randomized study. Sedation and anxiolysis scores before induction, cooperation at induction of anaesthesia and recovery times and complications were assessed. We found that both drugs effectively sedated the children within 20 min of administration. ⋯ No important side effects were attributable to either premedication. The time until the children were fit for discharge from the hospital after midazolam was approximately 20 min less than after ketamine. In conclusion, midazolam and ketamine offer similar clinical characteristics when used as oral premedications for children undergoing ambulatory surgery, although the time to discharge from hospital may be more rapid after midazolam than after ketamine.
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The purpose of the study was to determine the effect of nondepolarizing muscle relaxants and waiting time on muscle fasciculations after succinylcholine in anaesthetized patients. Adult men and women, 60-80 kg, received pretreatment doses of atracurium 5 mg (n = 160), pancuronium 1 mg (n = 123), d-tubocurarine 3 mg (n = 97), or vecuronium 1 mg (n = 62). Waiting times between pretreatment and succinylcholine, 100 mg, ranged between 0.6 and 5 min. ⋯ Following wait times of three, four and five minutes, the probability of not fasciculating was greatest with d-tubocurarine (90, 97 and 99%, respectively) and atracurium (89, 93 and 96%). Corresponding values for pancuronium were 70, 82 and 88% and for vecuronium were 74, 82 and 86%. Waiting times to prevent fasciculations in 80% and 90% of patients were shorter with d-tubocurarine (2.46 and 3.02 min, respectively) or atracurium (2.16 and 3.24 min) than pancuronium (3.77 and 5.35 min) or vecuronium (3.73 and 6.36 min).(ABSTRACT TRUNCATED AT 250 WORDS)