Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Clinical Trial
Sugarless gum chewing before surgery does not increase gastric fluid volume or acidity.
Patients occasionally arrive in the operating suite chewing gum despite instructions to avoid oral intake for a specific number of hours before surgery. Some anaesthetists are hesitant to proceed with these patients fearing an increase in gastric volume and acidity. This study was undertaken to determine if gum chewing increased gastric volume and acidity. ⋯ There was no difference between groups in terms of gastric volume or pH. In addition, there was no relationship between gastric content and the length of time from gum discard to induction or the length of time gum was chewed. In conclusion, the data suggest that induction of anaesthesia is safe and surgery does not need to be delayed if a patient arrives in the OR chewing sugarless gum.
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A two-dimensional model of the factors relevant to difficult laryngoscopy was analysed mathematically to determine clinical implications and limitations. The model describes the space into which the "inevitable residual volume" of the tongue (that part remaining anterior to the blade at laryngoscopy) can be displaced to permit a view of the larynx. Four points are used: the tip of the upper incisors; a point on the anterior airway just above the larynx; the mid-point between the mandibular condyles and the internal mid-point of the symphysis. ⋯ An otherwise normal jaw with this configuration recedes markedly on opening. Further studies are required to validate the model. Accurate quantification of individual factors in difficult laryngoscopy may then be feasible.
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The combined spinal-epidural technique is a modification of epidural analgesia which combines the rapid onset of spinal analgesia with the flexibility of an epidural catheter. We sought to evaluate the effectiveness of an intrathecal opioid--low-dose local anaesthetic combination for parturients in advanced labour, a setting where satisfactory epidural analgesia is often difficult to achieve. The technique was evaluated in an open-label, non-randomized trial using parturients in advanced, active labour for the provision of pain relief during the late first stage and second stage of labour. ⋯ Onset of analgesia was rapid (< five minutes) in all cases. Twenty-three patients (60%) delivered vaginally with no additional anaesthetic. The remaining 15 had supplemental local anaesthetic given via the epidural catheter, a mean of 123 +/- 33 min after the original spinal dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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The purpose of this report is to describe a new complication of epidural blood patch for inadvertent dural puncture. A dural tap in an obstetric patient was managed initially with a prophylactic blood patch via the epidural catheter. Despite this, 48 hr later, she developed post-dural puncture headache, neck, and shoulder pain, and was given a second epidural blood patch. ⋯ There were no further sequelae. Although severe complications of epidural blood patch are rare, they are alarming. Exacerbation of the original symptoms of post-dural puncture headache caused by, or following, epidural blood patching has not previously been reported.