Canadian journal of anaesthesia = Journal canadien d'anesthésie
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This clinical study was designed to assess the results of new preoperative fasting guidelines in which patients are instructed that they must not eat any solid food after midnight, but that they may drink unrestricted amounts of clear fluid until three hours before their scheduled time of surgery. We studied 199 healthy, elective surgical inpatients aged 18-70 yr to determine whether there was any correlation between the ingestion interval or the volume of fluid ingested, with the volume and pH of residual gastric fluid at induction of anaesthesia. Pregnant patients, and those with gastric disorders or who were taking medications that affect gastric motility or secretion, were excluded. ⋯ The remaining 94 patients did not drink because they were scheduled for surgery before 11:00 (n = 51), they did not want to drink (n = 24), or they were advised not to drink by their nurse or surgeon (n = 16). Following induction of anaesthesia, gastric fluid was aspirated through a #18 Salem sump orogastric tube, the volume was recorded and pH was measured with a calibrated pH meter. Patients were divided retrospectively into four groups (in three of which patients ingested fluid) according to the ingestion-induction interval (1.3-3.0 hr, 3.1-5.0 hr, 5.1-8.0 hr, and nothing by mouth after midnight).(ABSTRACT TRUNCATED AT 250 WORDS)
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The use of blood products in 1480 consecutive cases of adult cardiac surgical procedures over a period of 15 mth was studied retrospectively using the database of the Department of Anaesthesia of the Institut de Cardiologie de Montréal. Use of blood products was compared in patients having (1) coronary artery bypass grafting, (2) valvular surgery, (3) or a combination of 1 and 2. First operations were compared with reoperations. ⋯ Repeat CABG was associated with an intermediate exposure to homologous blood products (eight units). Finally, primary and repeat combined procedures, and repeat valve surgery were associated with the greatest exposure to foreign blood products (10, 13 and 10 units respectively). The data presented in this study provide a rational basis for stratification of procedures according to the expected use of blood products, particularly in view of future studies which may be planned to examine the efficiency of blood conservation strategies.
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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.
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Randomized Controlled Trial Clinical Trial
Epidural fentanyl does not influence intravenous PCA requirements in the post-caesarean patient.
Forty ASA physical status I or II patients scheduled for elective Caesarean delivery were studied to determine the effect of epidural fentanyl on post-Caesarean delivery analgesic requirements as administered by intravenous patient-controlled analgesia (PCA). Following delivery of the infant, under epidural anaesthesia with lidocaine 2% with 1/200,000 epinephrine, patients were randomly assigned to receive either 10 ml of preservative-free normal saline via the epidural catheter or 100 micrograms of fentanyl with 8 ml preservative-free normal saline in a double-blinded fashion. ⋯ No differences were observed in any values between the groups. It is concluded that a single bolus of epidural fentanyl does not provide an advantage for postoperative pain relief in this patient population.