Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Pulmonary hypertension and cardiomyopathy: anaesthetic management for caesarean section.
Pulmonary hypertension in pregnant women is uncommon but is associated with a high mortality. We present the case of a 14-yr-old parturient with pulmonary hypertension and cardiomyopathy who required a Caesarean section. ⋯ The successful use of lumbar epidural anaesthesia with lidocaine and fentanyl is described. When the local anaesthetic was administered slowly and in increments, epidural anaesthesia was safe for both mother and fetus.
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Randomized Controlled Trial Comparative Study Clinical Trial
Brachial plexus block with bupivacaine: effects of added alpha-adrenergic agonists: comparison between clonidine and epinephrine.
The effects of clonidine and epinephrine, administered into the brachial plexus sheath, were evaluated in 60 patients who underwent surgery of the upper limb. All patients received 40 to 50 ml of 0.25% bupivacaine, injected into the brachial plexus sheath, using the supraclavicular technique. The patients were randomly allocated to two groups so that 30 patients received 150 micrograms clonidine hydrochloride (Group I), and 30 received 200 micrograms epinephrine (Group II). ⋯ The block produced with the addition of clonidine was longer (994.2 +/- 34.2 vs 728.3 +/- 35.8 min) and superior to that with epinephrine (P less than 0.001). No major side-effects were recorded. We conclude that the injection of clonidine into the brachial plexus sheath is an attractive alternative to epinephrine to prolong the duration of analgesia following upper limb surgery under conduction anaesthesia.
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A 23-yr-old woman presented in labour and hepatic failure. The clinical diagnosis was acute fatty liver of pregnancy. A Caesarean section was performed under epidural anaesthesia, after correction of a coagulopathy. Epidural anaesthesia was chosen because of the potential deleterious effects of general anaesthesia on liver blood flow and function.
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Randomized Controlled Trial Clinical Trial
Nitrous oxide potentiates vecuronium neuromuscular blockade in humans.
This study was designed to measure the potency of vecuronium with and without nitrous oxide. Anaesthesia was induced with thiopentone and fentanyl in 56 adult patients. The subjects were randomly assigned to receive nitrous oxide, 70%, or intermittent boluses of thiopentone and fentanyl for maintenance of anaesthesia. ⋯ By analysis of covariance, the dose-response curves were shown to be shifted with respect to one another (P less than 0.05). Administration of nitrous oxide was associated with a 19.5% increase in potency (95% confidence limits: 1.7 to 40.4%). It is concluded that nitrous oxide has a slight potentiating effect on neuromuscular blockade, and that this effect occurs within five to ten minutes after the beginning of its administration.