Canadian journal of anaesthesia = Journal canadien d'anesthésie
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A 68-yr-old man presented for pharyngeal biopsy under general anaesthesia. Coincidentally he was found to have a large mediastinal mass. ⋯ The exact risk of catastrophic airway collapse on induction of anaesthesia in patients with mediastinal masses is controversial but probably small. As there is no test to prevent airway collapse, it is suggested that attempts at biopsy be performed with regional anaesthesia after radiotherapy.
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Randomized Controlled Trial Clinical Trial
Optimizing sedation following major vascular surgery: a double-blind study of midazolam administered by continuous infusion.
A randomized, double-blind study was undertaken to determine the dose requirements, recovery characteristics, and pharmacokinetic variables of midazolam given by continuous infusion for sedation in patients following abdominal aortic surgery. Thirty subjects, 50-75 yr, scheduled to undergo aortic reconstructive surgery, entered the study. Following a nitrous oxide-isoflurane-opioid anaesthetic technique, patients were randomly allocated to receive one of three loading doses (0.03, 0.06 or 0.1 mg.kg-1) and initial infusion rates (0.5, 1.0 or 1.5 micrograms.kg-1.min-1) of midazolam, corresponding to groups low (L), moderate (M) and high (H). ⋯ Times to awakening were longer in Group H: 3.1 +/- 3.4 hr, than in Group L: 1.1 +/- 0.8 h, P < 0.05. Pharmacokinetic variables were found to be dose-independent over the range of infusion rates. Mean values were t1/2 beta = 4.4 +/- 1.5 hr, CL = 5.94 +/- 1.69 mL.min-1.kg-1, Vd = 3.13 +/- 1.07 L.kg-1.(ABSTRACT TRUNCATED AT 400 WORDS)
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We present a case of 100% pneumothorax in a 41-yr-old man with a history of gastritis and gastroesophageal reflux scheduled for Nissen fundoplication. The patient was anaesthetized, and insufflation of the abdominal cavity with carbon dioxide was performed uneventfully. There was an increase in the peak inspiratory pressure and wheezing was noted with a decrease in the arterial oxygen saturation to 91%. ⋯ A chest roentgenogram showed a 100% left pneumothorax. A left chest tube was placed with immediate improvement of the arterial oxygen saturation to 100%. We recommend monitoring of arterial oxygen saturation, peak inspiratory pressures, and excursion of the chest for early diagnosis and prompt treatment of pneumothorax during laparoscopic procedures.
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This case report demonstrates embolization of echogenic material detected by transoesophageal echocardiography during a cemented total hip arthroplasty in a 76-yr-old woman without patent foramen ovale. During the placement of the acetabular and femoral components, and during relocation of the hip joint, a "snow flurry" appearing in the right atrium was followed by several highly echogenic and mobile emboli of various sizes, some of them with a vermiform shape 1 to 5 cm long. ⋯ Also, no desaturation was detected by pulse oximetry and blood gases at the time of embolism and there was no decrease in PETCO2. This case report is in line with other studies which failed to show a haemodynamic impact of TEE detected emboli during THA.
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Editorial Historical Article
A new post: laureate of the history anaesthesia.