Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Clinical Trial
Amrinone, in combination with norepinephrine, is an effective first-line drug for difficult separation from cardiopulmonary bypass.
A crucial element for weaning patients from cardiopulmonary bypass (CPB) rests on the selection of an appropriate therapeutic regimen. Amrinone, a phosphodiesterase III inhibitor, combines inotropic support with pulmonary and systemic vasodilatation, without increasing heart rate (HR) or myocardial oxygen consumption. These characteristics should be useful in the failing heart during weaning from CPB. ⋯ Successful weaning from CPB was possible 12 +/- 8 min after the amrinone bolus. Weaning resulted in a cardiac index similar to that measured pre-bypass. Amrinone is rapidly effective during weaning from CPB and, in combination with norepinephrine, provides the necessary inotropic support during this unstable period.
-
To remedy the lack of information about the continuing medical education (CME) practices of anaesthetists, we designed a survey to define and compare the CME activities of specialist anaesthetists in community-based and university-affiliated practices: 463 members of the Canadian Anaesthetists' Society in the Province of Ontario (263 community-based and 200 university-affiliated (University of Toronto) anaesthetists). Data from 304 (65.6%) respondents (172 community-based and 132 university-affiliated anaesthetists) were analyzed by non-parametric analysis (statistical significance P < 0.05). Most respondents spent between two to four hours per week on CME activities. ⋯ Formal teaching, including seminars, workshops, and annual society meetings, although the second most commonly used technique to obtain CME, was considered as effective as journal reading. Instructional media techniques were the least commonly used and considered the least effective (P < 0.05). Most community-based and university-affiliated anaesthetists obtained CME by a variety of techniques; of all respondents, 77% have no formal method of assessing their learning needs and 88% would consider participation in a formalized learning needs assessment programme.
-
A survey of postoperative pain management practices was mailed to the 56 Canadian university-affiliated teaching hospitals in December 1991. The aims of the survey were (1) to determine the prevalence, structure, and function of Acute Pain Services and (2) to determine the use and management of patient-controlled analgesia (PCA) and epidural opiate analgesia (EOA) in teaching hospitals. Responses were received from 47 hospitals, representing a return rate of 84%. ⋯ No deaths were reported at the time of the survey. Epidural opioid-local anaesthetic EOA-LA combinations were used at 26 (63%) hospitals; however, only six administered these combinations on general words. We conclude that a multidisciplinary team approach to manage postoperative pain is viable in university teaching hospitals of all sizes.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Comparative Study
Assessment of double-burst monitoring at 10 mA above threshold current.
We compared fade measurements in response to double-burst stimulation (DBS) at 10 mA above the threshold for the second response (D2) to that for DBS at 60 mA in order to determine the utility of low-current DBS testing. In 20 healthy adults undergoing general endotracheal anesthesia with isoflurane 0.5-1% end-tidal, a vecuronium infusion (0.25-1.5 micrograms.kg-1 x min-1) was delivered until a stable train-of-four (TOF) response to ulnar nerve stimulation was documented with an adductor pollicis force transducer. Then DBS responses were recorded, and the D2/D1 ratios were determined at 60 mA and at 10 mA above the D2 threshold current (TS + 10 mA). ⋯ A strong correlation was noted between the degrees of fade determined at the low and high currents (r = 0.95). We conclude that, although stimulation at 10 mA above the D2 threshold is associated with a slight negative bias, it is virtually interchangeable with testing at higher current in the clinical setting. This technique thus may be used effectively to monitor neuromuscular fade in settings where neurostimulation with low current is deemed desirable.
-
The effects of dobutamine (DOB) on diaphragmatic fatigue were examined in 20 anaesthetized, mechanically ventilated dogs. Animals were divided into two groups: the DOB group (n = 10) and the control group (n = 10). Diaphragmatic fatigue was induced by intermittent supramaximal electric stimulation applied to bilateral phrenic nerves at a frequency of 20 Hz for 30 min. ⋯ In the control group, the speed of recovery from fatigue was much slower at low-frequency stimulation. The integrated diaphragmatic electric activity (Edi) in the two groups did not change throughout the experiment at any frequency of stimulation. We conclude that dobutamine improves contractility in fatigued diaphragm.