Canadian journal of anaesthesia = Journal canadien d'anesthésie
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It has been speculated that the severity of obstructive sleep apnea syndrome (OSAS) is related to difficult intubation. However, this has not been confirmed in OSAS patients. Thus, we undertook a retrospective study to assess this relationship in patients who had undergone uvulopalatopharyngoplasty (UPPP) surgery for OSAS. ⋯ This study shows that the occurrence of difficult intubation can be predicted using AHI in patients who undergo UPPP surgery for OSAS.
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Case Reports
Targeted thoracic epidural blood patch placed under electrical stimulation guidance (Tsui test).
This case report describes the use of electrical epidural stimulation (Tsui test) to confirm accurate placement of a thoracic epidural catheter when administering an epidural blood patch for headache management in a patient suffering from spontaneous intracranial hypotension. ⋯ The use of electrical stimulation guidance may be useful when precise epidural blood patch placement is required.
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To assess red blood cell transfusion practices among Canadian anesthesiologists. ⋯ There was significant variation in transfusion practices among Canadian anesthesiologists. The type of surgical procedure, patient's age and a history of coronary artery disease influenced reported transfusion threshold. Practice variation in specific subgroups would support the need for further research to identify optimal transfusion thresholds.
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To report the anesthetic management of labour pain and Cesarean section in a patient with urticaria pigmentosa at risk for systemic mastocytosis. CLINICAL: A 37-yr-old patient with a history of urticaria pigmentosa and an allergic reaction to a local anesthetic agent was seen in consultation at 36 weeks gestation. She previously tested negative for an allergy test to lidocaine. Recommendations to avoid systemic mastocytosis included: avoidance of histamine-releasing drugs, using lidocaine for labour epidural, and regional anesthesia in case of a Cesarean section. The patient presented at term in labour. Intravenous fentanyl was used for early labour, followed by a combined spinal-epidural. The spinal contained lidocaine and fentanyl, but because of pruritus, the epidural infusion contained lidocaine only. Most likely because of tachyphylaxis to lidocaine, an epidural bolus of lidocaine with epinephrine failed to provide adequate anesthesia for a Cesarean section. The block was supplemented with nitrous oxide by mask, with fentanyl postdelivery. Postoperative pain control was managed with an epidural infusion of lidocaine and fentanyl for three days. The patient was discharged without complications four days postsurgery. ⋯ Proper allergy testing prior to pregnancy is important to help the management of labour pain and anesthesia for Cesarean section in a patient at risk for systemic mastocytosis.
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Tracheal rupture is an uncommon and potentially life-threatening event. This report presents a case of postoperative tracheal rupture in a patient with a known difficult airway presenting to a rural hospital. ⋯ Management of tracheal rupture in the patient with a difficult airway is a challenging problem, especially, in a rural hospital. This case highlights the need for skilled staff and resources to manage a difficult airway in the emergency room.