Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comparative Study Clinical Trial Controlled Clinical Trial
Effects of calcium channel blockers on circulatory response to tracheal intubation in hypertensive patients: nicardipine versus diltiazem.
We studied the circulatory responses to laryngoscopy and tracheal intubation in 37 hypertensive patients who received nicardipine 30 micrograms.kg-1 iv (Group N, n = 12), diltiazem 0.3 mg.kg-1 (Group D, n = 12) or saline placebo (Group C, n = 13) 60 sec before the initiation of laryngoscopy. Anaesthesia was induced with thiopentone 5 mg.kg-1 iv, and succinylcholine 2 mg.kg-1 iv was used to facilitate tracheal intubation after precurarization with vecuronium 0.02 mg.kg-1 iv. ⋯ The increase in MAP following tracheal intubation in Groups N and D was lower than that in Group C (P < 0.05). We conclude that, compared with nicardipine, administration of diltiazem iv is associated with less circulatory response to tracheal intubation in hypertensive patients.
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Transient neurological symptoms have been reported after hyperbaric lidocaine 5% spinal anaesthetics. We report a patient with neurogenic back and leg pain after uncomplicated bupivacaine and morphine spinal anaesthesia. A healthy 39-yr-old woman received 1.6 ml hyperbaric bupivacaine 0.75% and 250 micrograms morphine intrathecally. ⋯ Treatment was started with amitriptyline and the symptoms resolved slowly. Complete recovery occurred over three months. Further studies to assess symptoms after spinal anaesthesia are indicated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Midazolam for caudal analgesia in children: comparison with caudal bupivacaine.
In a randomized, double-blind study we have examined the analgesic efficacy of caudal administration of midazolam, bupivacaine, or a mixture of both drugs in 45 children, undergoing inguinal herniotomy. They were allocated randomly into three groups (n = 15 in each) to receive a caudal injection of either 0.25% bupivacaine 1 ml.kg-1 with or without midazolam 50 micrograms.kg-1 or midazolam 50 micrograms.kg-1 with normal saline 1 ml.kg-1. There were no differences in quality of pain relief, postoperative behaviour or analgesic requirements between the midazolam group and the other two groups. ⋯ Further, the bupivacaine-midazolam group received fewer (P < 0.05) doses of paracetamol than the bupivacaine group. Side effects such as motor weakness, respiratory depression or prolonged sedation were not observed in patients who received caudal epidural midazolam only. We conclude that caudal midazolam in a dose of 50 micrograms.kg-1 provides equivalent analgesia to bupivacaine 0.25%, when administered postoperatively in a volume of 1 ml.kg-1 for children following unilateral inguinal herniotomy.
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Randomized Controlled Trial Clinical Trial
Perioperative administration of caffeine tablets for prevention of postoperative headaches.
Interruption of daily caffeine consumption can cause caffeine withdrawal headache. As headache ranks among the most frequent minor postoperative sequelae, the impact of perioperative substitution of caffeine on the incidence of postoperative headache was evaluated. Forty patients undergoing minor surgical procedures with general anaesthesia were randomly allocated to receive either placebo or caffeine tablets at a dosage equal to their individual average daily caffeine consumption. ⋯ Ten patients (50%) who received placebo reported headaches, which persisted in seven patients (35%) until the next day. No patient receiving caffeine substitution therapy reported headache following surgery, and only one complained of headache on postoperative day 1. We suggest that the prophylactic administration of caffeine tablets might be considered for surgical patients who are accustomed to a high daily intake of caffeine.
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Tracheal intubation under direct vision using a laryngoscope can be challenging and difficult even in experienced hands. Transillumination of the soft tissues of the neck using a lighted-stylet (lightwand) is one of many effective alternative intubating techniques developed during the past several decades. While many versions of lightwand have been available, each has its limitations. ⋯ It is a light-guided technique in which there is no direct visualization of the upper airway structures. It should be avoided in patients with known anatomical abnormalities of the upper airway and used with caution in patients in whom transillumination of the anterior neck may not be achieved adequately. As with any intubating technique, successful intubation using the Trachlight relies on the preparation of the patient and the operator's skill and experience.