Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The authors evaluated the accuracy of an intrathecal test dose (TD) to rule out unintentional subarachnoid injection in a prospective and double-blind study. Twenty-nine unmedicated patients scheduled to receive continuous spinal analgesia for their surgical procedures entered the study. After placement of non-invasive monitoring (ECG, BP and SpO2), an intrathecal catheter was placed in the lumbar area. ⋯ At four minutes SN reached 100% (CI 78-100%) for R and H, while only R obtained a SP of 93% (CI 66-100%). Using R as detector of intrathecal injection the -PV was 100% and the +PV 25% (assuming a 2% prevalence of unintentional spinal). We conclude that, with our test dose; (a) four minutes are needed to recognize signs of intrathecal injection; (b) leg-raising is a reliable sign; and (c) inquiring about other signs may only decrease the diagnostic accuracy of this test.
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The use of epidural analgesia has become so widespread in recent years that many women are now requesting repeat epidural analgesia for their second or subsequent labour. This study examines the incidence of problems at insertion and of inadequate block in 71 multiparae having second epidurals compared with 150 primiparae having their first epidural. ⋯ Epidurals were inserted at a greater dilatation (P < 0.05) and there was a shorter time to delivery (P < 0.01) in the multiparous group. We conclude that unilateral block is thus more common in women receiving repeat epidurals.
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In order to determine the prevalence of psychoactive substance use in three specialty groupings, 1,624 questionnaires were sent to physicians in medicine, surgery and anaesthesia; all had trained at the same academic institution. A response rate of 57.8% was achieved. Comparison of prevalence of impairment rates showed no differences between Surgery (14.4%), Medicine (19.9%) and Anaesthesia (16.8%). ⋯ Seventy-three used psychoactive drugs which were non-prescribed. Drug counselling programmes were judged inadequate by most. Use of alcohol and drugs by faculty members was reported by a number of respondents.
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The cuff of the laryngeal mask airway (LMA) is highly permeable to nitrous oxide (N2O), and cuff pressure increases during N2O/O2 anaesthesia. The extent of these changes and their effect on LMA position have previously only been investigated for short procedures. The current study was designed to investigate the effects of nitrous oxide-oxygen (N2O/O2) anaesthesia lasting one to two hours on cuff pressure, LMA positioning and pharyngeal morbidity. ⋯ Three of 19 patients had a mild sore throat. This study demonstrates that the increase in LMA cuff pressure is self limiting over a one-to-two-hour period and does not cause displacement of the LMA. There is no evidence that cuff pressure monitoring and pressure limitation is necessary during LMA anaesthesia.