Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Vecuronium dose requirement and pupillary response in a patient with olivopontocerebellar atrophy (OPCA).
Olivopontocerebellar atrophy (OPCA), a variant of spinocerebellar degeneration (Shy-Drager syndrome), is a systemic degenerative disorder affecting the neurons of multiple nuclei. We investigated the sensitivity to vecuronium and the pupillary responses to various stresses in a patient with OPCA. ⋯ The absence of pupillary and SEF90 responses to noxious stimuli suggests a sensitivity to propofol and/or central autonomic dysfunction in patients with OPCA. Although the dose requirement of vecuronium in this patient was similar to that of the control patients, the effects of neuromuscular blockers may vary depending on the severity of muscle atrophy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Diltiazem-lidocaine combination for the attenuation of cardiovascular responses to tracheal intubation in hypertensive patients.
Hypertensive patients are prone to haemodynamic changes after laryngoscopy and tracheal intubation. This study was undertaken to compare the efficacy of a combination of diltiazem and lidocaine with that of each drug alone for suppressing the cardiovascular responses to tracheal intubation. ⋯ Prophylactic therapy with diltiazem-lidocaine combination is more effective than diltiazem or lidocaine alone for attenuating the cardiovascular changes associated with tracheal intubation in hypertensive patients.
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To report the occurrence of apnea and bradycardia in two former pre-term infants who received spinal anaesthesia without inhalational or intravenous anaesthetic agents during inguinal herniorrhaphy. ⋯ Apnea can occur when spinal anaesthesia is used as the sole anaesthetic technique in the former pre-term infant. Appropriate monitoring for such problems based on the infant's post-conceptual age is suggested.
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Adrenoleukodystrophy (ALD) is a rare genetic disorder. Findings include various central nervous system problems in addition to adrenal insufficiency. We present a case of an adult man with X-linked ALD undergoing surgery. ⋯ Patients with X-linked ALD are rarely seen in a clinical setting because the condition is so uncommon. Adrenal insufficiency, mental retardation, and osteoporosis are major considerations for these patients. In addition, these patients are at risk for reflux, seizures, and major post-operative complications.
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Although thromboelastography is useful for measuring both coagulability and fibrinolysis, it takes about two hours to measure all parameters including fibrinolytic rate. The present study aimed to investigate the usefulness of celite-activated thromboelastography (TEGc) to evaluate fibrinolytic status in non-cardiac surgery. ⋯ TEGc is a useful technique for a more rapid assessment of fibrinolytic status.