Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
The median effective seated time for hypotension induced by spinal anesthesia at Cesarean delivery with two doses of hyperbaric bupivacaine: a randomized up-down sequential allocation study.
Extending the time a parturient is left sitting after induction of spinal anesthesia (i.e., the seated time) has had varying success in decreasing hypotension at Cesarean delivery. This may be due to the current lack of information concerning the dose-response relationship of seated time and rates of hypotension. ⋯ There exists a seated time after intrathecal injection of hyperbaric bupivacaine where 50% of parturients do not experience hypotension. This seated time increases with an increased dose of bupivacaine. Further work is required to determine the full relationship between seated time and hypotension for other doses of anesthetic and to investigate the clinical utility of this technique for prevention of hypotension. This trial was registered at www.clinicaltrials.gov (NCT01561274).
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The objective of this study was to assess the influence of a teaching plan consisting of didactic teaching and repeated simulations on the performance of anesthesia residents in the management of general anesthesia (GA) for emergency Cesarean delivery (CD). ⋯ Didactic teaching followed by simulation sessions enhances not only the technical skills but also the non-technical skills of residents, most likely due to the feedback received after the first simulation session. Repeated simulation sessions may help prepare residents to deal more effectively with similar critical situations in clinical practice with minimum errors.
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Acute severe asthma is a life-threatening form of bronchial constriction in which the progressively worsening airway obstruction is unresponsive to the usual appropriate bronchodilator therapy. Pathophysiological changes restrict airflow, which leads to premature closure of the airway on expiration, impaired gas exchange, and dynamic hyperinflation ("air-trapping"). Additionally, patients suffering from asthma for a prolonged period of time usually have serious comorbidities. These conditions constitute a challenge during the treatment of this disease. Therapeutic interventions are designed to reduce airway resistance and improve respiratory status. To achieve therapeutic goals, appropriate bronchodilator treatment is indispensable, and mechanical ventilation under adequate sedation may also be required. The volatile anesthetic agent, sevoflurane, meets both criteria; therefore, its use can be beneficial and should be considered. ⋯ The volatile anesthetic agent, sevoflurane, is used widely in anesthesia practice. Its utility for treatment of refractory bronchospasm has been appreciated for years; however, its administration was difficult within the environment of the intensive care unit due to the need for an anesthesia machine and a scavenging system. The introduction of the AnaConDa eliminates these obstacles and makes the use of sevoflurane safe and simple. Our case report reveals the potential of sevoflurane as a "two-in-one" (bronchodilator and sedative) drug to treat a severe acute asthma attack.