Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The purpose of this narrative review is to summarize the evidence derived from randomized controlled trials (RCTs) regarding established approaches and techniques for brachial plexus anesthesia. ⋯ Published reports of RCTs provide evidence to formulate limited recommendations regarding optimal approaches and techniques for brachial plexus anesthesia. Further well-designed and meticulously executed RCTs are warranted, particularly in light of new techniques involving ultrasound or combining neurostimulation and echoguidance.
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Randomized Controlled Trial Comparative Study
Remifentanil patient-controlled analgesia for labour: optimizing drug delivery regimens.
A pilot study was undertaken to compare the efficacy of two regimens of intravenous patient-controlled analgesia (PCA) with remifentanil for labour analgesia. ⋯ Although pain and satisfaction scores were similar in both groups, the regimen used in Group A was associated with fewer side effects compared to the Group B dosing regimen. This pilot study suggests that remifentanil intravenous PCA is efficacious for labour analgesia as a bolus of 0.25 microg x kg(-1), with a lockout interval of two minutes and continuous infusion of 0.025-0.1 microg x kg(-1) x min(-1). The potential for respiratory depression mandates close respiratory monitoring. Large-scale trials to evaluate safety issues are warranted.
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The lumbosacral cerebrospinal fluid (CSF) volume, as assessed by magnetic resonance imaging, is a major determinant of the intrathecal spread of local anesthetics. Ultrasound imaging of the lumbar spine allows measurement of dural sac dimensions, which we hypothesize can be used to estimate CSF volume. The purpose of this study was to investigate whether the dural sac antero-posterior diameter correlates with sensory levels of spinal anesthesia during elective Cesarean delivery (CD). ⋯ The lumbar DSD, as determined by ultrasound, is not a predictor of spinal anesthesia spread. Further research is necessary to understand if ultrasound findings can be used to predict intrathecal spread of local anesthetics.
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Case Reports
Repetitive generalized seizure-like activity during emergence from sevoflurane anesthesia.
Sevoflurane-induced seizures are most often described during mask induction of anesthesia when high concentrations of the volatile agent are administered concomitant with alveolar hyperventilation. The occurrence of seizure-like activity during emergence from sevoflurane anesthesia has been rarely reported. ⋯ The report emphasizes that sevoflurane is capable of producing excitatory central nervous system (CNS) phenomena in spite of causing primarily CNS depressant effects.
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To describe the anesthetic and peripartum management of a parturient with paroxysmal nocturnal hemoglobinuria complicated by severe preeclampsia, review the pathophysiology of this condition, rationale for thromboembolic prophylaxis, and its implications on the choice of labour analgesia and anesthesia. ⋯ Paroxysmal nocturnal hemoglobinuria is associated with an increased risk of venous thromboembolism, and so anticoagulation therapy assumes primary importance. The use of LMWH for prophylaxis in combination with thrombocytopenia may contraindicate neuraxial anesthesia. General anesthesia should be aimed at preventing or exacerbating complement mediated intravascular hemolysis.