Canadian journal of anaesthesia = Journal canadien d'anesthésie
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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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Case Reports
Tracheal rupture following blunt chest trauma presenting as endotracheal tube obstruction.
In this report, we describe a patient in whom a tracheal tear followed blunt thoracic trauma. The diagnosis was made late resulting in problems with ventilation, endotracheal tube obstruction and cardiac arrest. ⋯ A review of airway management has been made as it requires combined anaesthetic and surgical expertise. Injuries of the trachea may have severe, life-threatening consequences and early diagnosis and management reduce morbidity and mortality.
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The effects of positive end-expiratory pressure (PEEP) and lung compliance (CL) on delivered tidal volume (VTdel) and ventilator output were evaluated in the following anaesthesia machine/ventilator systems: Narkomed III with a Model AV-E ventilator (III/AV-E system) and an Ohmeda Modulus II with either a 7810 anaesthesia ventilator (II/7810 system) or a Model 7000 anaesthesia ventilator (II/7000 system). With a standard circle anaesthesia breathing circuit connected to a test lung simulating CL, gas flow was measured and integrated over time at each combination of VT settings (VTset), 500 ml or 1000 ml; CL settings, 0.15 to 0.01 L.cm H2O-1 decreased incrementally; and PEEP settings, 0 to 30 cm H2O increased in 5-cm H2O increments. ⋯ As CL decreased to 0.01 L.cm H2O-1 and PEEP increased to 30 cm H2O, at VTset of 500 ml and 1000 ml, respective VTdel decreased linearly to 251 +/- 6 ml and 542 +/- 7 with the III/AV-E, 201 +/- 5 and 439 +/- 5, with the II/7810, and 181 +/- 4 and 433 +/- 7 ml with the II/7000 (P < 0.05 among the three systems). Loss in VTdel due to PEEP alone, which increased only slightly when VTset was increased, accounted for an increasingly greater percentage of VTset as it was decreased, which was less pronounced with low CL.(ABSTRACT TRUNCATED AT 250 WORDS)
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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 Comparative Study Clinical Trial
Post-tonsillectomy infiltration with bupivacaine reduces immediate postoperative pain in children.
Pain management after tonsillectomy in children remains a dilemma for the anaesthetist. A previous study demonstrated that the administration of lidocaine 1% topical spray to the peritonsillar fossae before tracheal extubation provided considerable immediate postoperative pain relief in infants and children. However, the pain relief was of short duration. ⋯ Peritonsillar infiltration of bupivacaine provided superior immediate postoperative analgesia as reflected by lower recovery room pain scores (P < 0.05) and opioid requirements (P < 0.01). Ward pain scores and analgesic requirements were similar among groups. Peritonsillar infiltration of bupivacaine 0.5% with 1:200,000 epinephrine provides better post-tonsillectomy pain control in the immediate postoperative period than bupivacaine spray or placebo.