Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of two types of epidural catheters.
The purpose of this study was to compare two epidural catheters--the Portex epidural catheter and Vas-Cath catheter. One hundred and fifty patients in labour who received epidural anaesthesia were selected and either one or the other catheter was used, based on random assignment. Ease of insertion, maintenance and removal of the catheter were assessed, as was the incidence of blood return and paraesthesiae during epidural catheter insertion. ⋯ However, the incidence of paresthesiae was 44 per cent with the Portex and 24 per cent with Vas-Cath catheters (p less than 0.008). The incidence of blood vessel trauma was 12 per cent with the Portex and 6.7 per cent with the Vas-Cath catheter (p = NS). Choice of epidural catheter is a factor to be considered in minimizing the incidence of blood vessel trauma or paresthesiae.
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Historical Article
The earliest ether anaesthetic in British North America--a first for Saint John, New Brunswick?
Literature relating the early history of ether anaesthesia in New Brunswick which, as part of British North America was a British colony until 1867, is reviewed. There is documentary evidence that the first ether anaesthetic for dental surgery in what is now Canada, was administered in 1844 in St. ⋯ There is also documentary evidence that the first ether anaesthetic for general surgery was administered in St. John on Monday, January 18, 1847, rather than in Montreal in March, 1847.
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A case of postoperative neuroleptic malignant syndrome is presented. A healthy 23-year-old male underwent a shoulder repair under uneventful fentanyl, halothane, nitrous oxide and oxygen anaesthesia. He received droperidol 5 mg IV and metoclopramide 10 mg IV intraoperatively to prevent postoperative nausea. ⋯ The supportive treatment of the patient included active cooling measures, muscle relaxation and mechanical ventilation. The ability of anti-dopaminergic agents, including metoclopramide and droperidol, to precipitate the neuroleptic malignant syndrome is discussed. Treatment of the neuroleptic malignant syndrome is briefly discussed.
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Evidence is reviewed demonstrating the high level of drug and alcohol abuse and marital disharmony among physicians and the particularly high rate among anaesthetists. The relationship between these factors and the effects of fatigue is explored. ⋯ Supplementary indirect evidence is surveyed which suggests that increased experience may not compensate adequately for this reduced performance. Since hours of work can be controlled, it is essential that anaesthetists, their professional organizations and regulatory agencies ensure that pressure for efficiency does not result in fatigue and the consequent compromise of both patient and physician health and safety.