Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Intrapleural placement of a nasogastric tube: an unusual complication of nasotracheal intubation.
Although rare, the misplacement of nasogastric tubes into the pleural space has been described. The prognosis of such injuries is improved by prompt recognition; therefore, it is important for physicians who practice nasogastric intubation to be aware of this potential complication, and to be familiar with an approach to early diagnosis. ⋯ Our experience with this case and a review of the relevant literature suggest that such trauma may predispose to malplacement of nasogastric tubes. Clinical signs, such as aspiration of fluid from a nasogastric tube, and auscultation of air insufflated into the stomach, are unreliable; however, the presence of subcutaneous air in the neck on chest radiograph, and the presence of cervical crepitance on physical examination, are valuable signs in the early diagnosis of perforation of the cervical oesophagus. Contrast oesophagography remains the diagnostic manoeuvre of choice in confirming the diagnosis, but early diagnosis will depend on a high index of suspicion and prompt viewing of chest x-rays. The management and the prognosis of such injuries depends on the level of the perforation, delays in diagnosis, and the presence of associated mediastinitis.
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Case Reports
Paradoxical vocal cord motion in the recovery room: a masquerader of pulmonary dysfunction.
We report a case of paradoxical vocal cord motion as an unusual cause of postoperative stridor and wheezing. A means of diagnosis and management is discussed. ⋯ Paradoxical vocal cord motion is an unusual cause of postoperative respiratory distress. A definitive diagnosis may be made by the use of a flexible fibreoptic laryngo-scope using topical anaesthesia.
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Randomized Controlled Trial Clinical Trial
Neostigmine but not edrophonium prolongs the action of mivacurium.
To examine the influence of anticholinesterase drugs neostigmine and edrophonium (which have different effects on plasma cholinesterase activity) administered for antagonism of neuromuscular block on the duration of action of mivacurium (a neuromuscular blocking drug metabolised by plasma cholinesterase). ⋯ The duration of action of mivacurium is prolonged by previous administration of neostigmine and this is most likely to be due to inhibition of PCHE activity.
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Randomized Controlled Trial Clinical Trial
Terbutaline inhalation suppresses fentanyl-induced coughing.
To study the suppressive effect of inhalation of a selective beta 2-adrenergic bronchodilator terbutaline, and the effect of an intravenous anticholinergic, atropine, on fentanyl-induced coughing. ⋯ The inhalation of a selective beta 2-adrenergic bronchodilator, terbutaline, effectively inhibited fentanyl-induced cough, whereas atropine, an antimuscarinic vagolytic, had no efficacy. Our results suggest that bronchoconstriction may underlie the mechanism on fentanyl-induced cough.
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Randomized Controlled Trial Clinical Trial
Epidural and intravenous bolus morphine for postoperative analgesia in infants.
To compare two doses of bolus epidural morphine with bolus iv morphine for postoperative pain after abdominal or genitourinary surgery in infants. ⋯ Epidural and iv morphine provide infants effective postoperative analgesia, although side effects are common. Epidural morphine gives satisfactory analgesia with fewer doses (less total morphine); epidural morphine 0.025 mg.kg-1 is appropriate initially. Infants receiving epidural or iv morphine analgesia postoperatively need close observation in hospital with continuous pulse oximetry.