Canadian journal of anaesthesia = Journal canadien d'anesthésie
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In patients with congestive heart failure, the release of atrial natriuretic peptide (ANP) is decreased. This study sought to determine the extent of ANP, sympathetic and haemodynamic responses to acutely increased atrial pressure in patients with cardiomyopathies undergoing orthotopic cardiac transplantation. Haemodynamic variables, plasma ANP, norepinephrine, and epinephrine concentrations were measured in 17 patients at five times before and after induction of anaesthesia using either ketamine 1.5 micrograms.kg-1 or sufentanil 3.6 +/- 0.3 micrograms.kg-1. ⋯ There were no differences in epinephrine concentrations in either group. Despite the anticipated haemodynamic and catecholamine differences found between the ketamine and sufentanil groups, the levels of plasma ANP were similar. Based upon these results, it is concluded that ANP exerts little influence in the control of fluid volume or blood pressure in patients with refractory cardiomyopathy.
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To ascertain the anaesthetic complications requiring post-anaesthetic respiratory support in a large obstetrical hospital, the hospital records of obstetrical patients admitted to an adjacent general intensive care unit (ICU) were studied. Obstetrical patients who required mechanical ventilation following anaesthetic complications were identified and their hospital records reviewed. In a ten-year period there were 61,435 women delivered at the Mater Mothers Hospital (MMH) in Brisbane, Queensland, Australia. ⋯ Complications included anaphylaxis, high block and failure of tracheal intubation. The incidence of a major complication of a GA causing admission to the ICU was 1 in 932 and for RA was 1 in 4177 when these were given for delivery (P less than 0.01). If a complication requiring ICU admission and mechanical ventilation is used as the criterion of safety it appears that RA is safer than a GA for delivery.
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We report a case of electrocautery-induced pacemaker failure that resulted in asystole in a 15-year-old girl scheduled for cardiac surgery. Her pacemaker was converted to the asynchronous mode the night before surgery. ⋯ Eventually the battery current drain caused VCO "lock-out," and pacemaker and battery failure. This report demonstrates that electrocautery-induced pacemaker failure can occur, even after conversion to asynchronous mode.
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Sunnybrook Health Science Centre is an adult regional trauma unit serving metropolitan Toronto and environs. We undertook a two-year retrospective review of patients admitted to our institution with blunt thoracic trauma. Three hundred and thirty-three patients with blunt trauma and an injury severity score (ISS) greater than 17 required emergency surgery. ⋯ Awake intubation was undertaken in 77.5% of patients requiring anaesthesia and surgery because of the potentially compromised airways and difficult intubations due to the nature of the associated injuries. Finally, 74% of patients undergoing urgent surgery required mechanical postoperative ventilation. The presence of blunt chest trauma should be considered a marker of the severity of injury sustained by the patient.