Canadian journal of anaesthesia = Journal canadien d'anesthésie
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We report the case of a 65-yr-old woman undergoing bronchoscopy for a lobular lesion who received thiopentone to induce anaesthesia that was maintained with sufentanil, vecuronium and isoflurane. She tolerated the procedure well initially, but developed eruptions about her face and fingers within 24 hr of anaesthesia. ⋯ The surgery was well tolerated and the patient was discharged after an uneventful postoperative course. This case is reported to heighten awareness of the delayed onset of adverse effects which may be associated with the use of thiopentone.
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Three cases are reported where pre-existing medical conditions (severe osteoporosis, amyotrophic lateral sclerosis, cardiac arrhythmias) made the administration of succinylcholine during ECT potentially dangerous. Therefore, mivacurium was substituted as the muscle relaxant necessary for safe therapy. Full reversal of the non-depolarizing muscle relaxant was assured by post-reversal use of the peripheral nerve stimulator with full recovery of train-of-four response.
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The study evaluated the warming ability and flow rates associated with four fluid warming devices during pressure driven infusion and during wide open gravity driven roller clamp infusion. Warmers tested were the Astotherm, Flotem IIe, Level 1 System 250 and a modified cardioplegia heat exchanger. Fluids tested were crystalloid, red cells diluted with 200 ml, 0.9% saline, and undiluted red cells. ⋯ Only the System 250 warmed red cells > 35 degrees C at gravity driven flow rates. The Flotem and Astotherm were not effective in warming rapidly infused solutions. None of the warmers tested was able to deliver fluids at normothermia (> 36.5 degrees C).
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The purpose of this article is to report the case of a patient who developed prolonged neuromuscular block after a large dose of clindamycin (2400 mg). A 58-yr-old, 65 kg woman with severe rheumatoid arthritis was admitted for wrist arthrodesis. After d-tubocurarine (3 mg) and fentanyl (1.5 micrograms.kg-1), anaesthesia was induced with thiopentone (4 mg.kg-1) followed by succinylcholine (1.5 mg.kg-1) and was maintained with N2O in O2 and isoflurane (0.75-1.0% end tidal) and ventilation was controlled. ⋯ Controlled ventilation was continued in the Recovery Room where neuromuscular testing showed a train-of-four ratio of 0.27 which improved to only 0.47 five minutes after calcium chloride (1.5 mg.kg-1 i.v.), and to 0.62 after edrophonium (20 mg) and neostigmine (2 mg). Nine hours later the patient began to cough, the TOF had returned to 1.0 and two hours later the trachea was extubated and spontaneous ventilation was resumed. Large doses of clindamycin can induce profound, long-lasting neuromuscular blockade in the absence of non-depolarizing relaxants and after full recovery from succinylcholine has been demonstrated.
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To study the detrimental effects of operating room noise, noise levels in operating rooms were first measured and the average noise level was calculated in Decibels, which was 77.32 dB(A). An audiocassette of 90 min duration was prepared recording the operating room noise. The same audiocassette was used later to expose the 20 anaesthesia residents to the operating room noise in the acoustically treated rooms of audiology department. ⋯ The mean pre-exposure scores for the Trail Making Test, Digit Symbol Test and Benton Visual Retention Test were 22.9 +/- 1.94, 83 +/- 2.62 and 9.55 +/- 0.51 respectively. The mean during-exposure scores were 16.35 +/- 1.39, 74.05 +/- 3.46 and 5.8 +/- 0.41 respectively (P < 0.05). In conclusion, we observed that operating room noise reduced the mental efficiency and short-term memory of anaesthesia residents.