Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Regional anaesthetic technique and the incidence of tourniquet pain.
The influence of regional anaesthetic technique on the incidence of lower extremity tourniquet pain was evaluated. We studied 60 patients undergoing orthopaedic procedures of the lower extremity with the use of a pneumatic tourniquet and anticipated inflation of 60 min or longer. Three different anaesthetic techniques were selected by random and draw; spinal anaesthesia (SAB) with plain 0.5% bupivacaine (15 mg) and 0.2 mg epinephrine added, lumbar epidural anaesthesia (EA) with 2% mepivacaine and 1:200,000 epinephrine added, and epidural anaesthesia (AEA) with the same solution alkalinized with bicarbonate. ⋯ There was no difference between SAB and AEA. This study demonstrated a lower incidence of tourniquet pain with spinal anaesthesia than with epidural anaesthesia to the same sensory level. However, this advantage is eliminated if the epidural anaesthetic was performed with an alkalinized local anaesthetic.
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Blockade of conduction in the saphenous nerve is important in providing surgical anaesthesia in the lower leg. Unfortunately, previously described techniques have lacked clinical effectiveness in practice. We developed a transsartorial approach for conduction block of the saphenous nerve. ⋯ The success rates of the BKFB and FPFB were 65% and 40% respectively. A successful block with the transsartorial approach provided complete anaesthesia of the medial malleolus in 94% of subjects whilst the BKFB and FPFB provided complete anaesthesia of the medial malleolus in less than 40% of the successful blocks. We recommend the transsartorial approach for more effective block of the saphenous nerve.
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Randomized Controlled Trial Comparative Study Clinical Trial
A clinical assessment of desflurane anaesthesia and comparison with isoflurane.
In 48 randomly assigned ASA I adult patients undergoing elective orthopaedic procedures, we compared the pharmacodynamics of desflurane (DF) and isoflurane (IF), and their pharmacokinetics during rapid induction of deep anaesthesia (via face mask, to 1.5-2 MAC, after thiopentone), maintenance of anaesthesia at 1.25 MAC, and emergence therefrom. During induction, laryngeal reactions ranging from mild crowing to laryngospasm occurred more frequently with DF than with IF (15/24 DF, 5/24 IF; P < 0.05) and was more severe (9/24 DF, 1/24 IF, excluding the mildest form, P < 0.05). As a result, induction of anaesthesia was not accomplished faster with DF, in spite of a faster equilibration between exhaled and inhaled concentrations. ⋯ Premature ventricular contractions did not occur in any patient even during periods of difficulty with the airway and oxygen desaturation. It is concluded that DF is a safe anaesthetic, pharmacokinetically superior to IF but clinically inferior for induction of anaesthesia via a face mask. Because of the fast equilibration, the exhaled concentration of DF can be controlled more precisely by the dial setting of the vaporiser.
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Comparative Study Clinical Trial Controlled Clinical Trial
Epidural morphine reduces the risk of postoperative myocardial ischaemia in patients with cardiac risk factors.
Perioperative myocardial ischaemia is a predictor of postoperative cardiac morbidity (PCM). Epidural anaesthesia and adequate perioperative analgesia have been shown to improve myocardial oxygen dynamics due to interruption of pain and sympathetic pathways. The aim of the present study was to compare the incidence of ischaemia after either general anaesthesia followed by parenteral analgesia with morphine or combined epidural/general anaesthesia followed by analgesia with epidural morphine. ⋯ Forty-two percent of ischaemic episodes were associated with a heart rate > 100 bpm, or an increase of 20% over the baseline heart rate. We conclude that epidural anaesthesia/analgesia reduces but does not eliminate the risk of myocardial ischaemia and tachyarrhythmia. We were unable to determine any associated reduction in the risk of PCM.
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We report a two-day-old infant who had a period of apnoea lasting six hours following the intravenous administration of succinylcholine (Sch). The results of her plasma cholinesterase level and dibucaine number indicate a congenital absence of plasma cholinesterase (PChE) enzyme, although both parents and siblings had normal cholinesterase levels and dibucaine numbers. This is believed to be the youngest reported case of prolonged apnoea after the administration of succinylcholine.