Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural anaesthesia for caesarean section: comparison of two injection techniques.
Two techniques of injection for epidural anaesthesia for Caesarean sections were studied. Forty-five patients were randomly divided into two groups. Patients in Group I received 20 ml of lidocaine two per cent with epinephrine via the needle at a rate of 5 ml.30 sec-1 after a 3 ml test dose. ⋯ The incidence of hypotension was 52.2 per cent in Group I and 13.6 per cent in Group II (P = 0.014). There was no significant difference in maternal and umbilical venous lidocaine concentrations. We conclude that injection in fractional doses is a safer and more efficient technique for epidural anaesthesia for Caesarean section.
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John Snow's leadership in epidemiology as well as anaesthesia resulted from his research as much as his clinical practice. In anaesthesia, Snow's research concerned the regulation of concentrations of volatile agents and the development of efficient inhalers; the uptake and elimination of volatile agents; stages of anaesthesia; carbon dioxide metabolism and rebreathing; and metabolism in anaesthesia and the theory of anaesthesia. ⋯ Snow's research, which has received less attention than anecdotes concerning his career (e.g., his anaesthetizing Queen Victoria and urging removal of the handle of a contaminated water pump), was always directed towards solving specific problems. The significance of his research is evident in its leading not only to improvements in health care but also to the evolution of anaesthesia and epidemiology as professional disciplines.
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Twenty-seven anaesthesia faculty, fellows and residents compared a standard intubating mannequin and an anaesthetized pig as models for teaching fibreoptic tracheal intubation. When likened to the clinical situation, the anatomic characteristics of the pig airway were rated as significantly more realistic than the airway characteristics of the mannequin with the exception of the appearance of the epiglottis. In addition, the overall score for the pig model was significantly higher than the score for the mannequin and 26 of 27 evaluators rated the anaesthetized pig as the more effective teaching model. We conclude that an anaesthetized, spontaneously breathing pig is a valid model for teaching fibreoptic endotracheal intubation.
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Clinical examination of a patient is very likely to reveal the factors making tracheal intubation difficult and thus increasing the likelihood of a traumatized temporo-mandibular joint or mouth. Although laryngoscopes and bronchoscopes incorporating fiberoptic visual devices are invaluable they are usually only employed for extremely difficult patients. ⋯ An atraumatic tracheal intubation will be assisted if the laryngoscope blade to be used is selected on the basis of the anatomic difficulties prescribed by the patient. The Miller, Jackson-Wisconsin, Macintosh, Soper, Bizarri-Guffrida, and Bainton blades together with appropriate handles and fittings comprise a group from which selection can be made.