Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Magnesium plays an important role as a cofactor in many of the body's critical functions and reactions. A deficiency or excess of extracellular magnesium can produce significant signs and symptoms. Hypomagnesaemia is a common finding in hospitalised patients, especially those in critical care areas. ⋯ Hypermagnesaemia is often iatrogenic and is more likely in patients with renal dysfunction who are receiving oral or parenteral magnesium. The specific antidote is intravenous calcium. Anaesthetised patients with high serum magnesium levels are at risk from hypotension, potentiation of non-depolarising neuromuscular blockers, postoperative respiratory failure and cardiac arrest.
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A 24-year-old black female presented for repeat elective Caesarean section. The procedure was performed under epidural anaesthesia. Sufentanil 25 micrograms, intended for postoperative analgesia, was inadvertently diluted to 10 ml with 15 per cent potassium chloride (KCl) instead of preservative-free normal saline (0.9 per cent NaCl). ⋯ Dexamethasone 10 mg was administered intravenously to reduce spinal cord oedema. Intravenous diazepam 10 mg and meperidine 75 mg were given for sedation and analgesia. Complete recovery occurred within 12 hours.
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Historical Article
Rivalries and controversies during early ether anaesthesia.
National and international rivalries can intrude into the arena of medical and scientific advances. Editorials and reports published in North American, British, and French medical journals in early 1847 regarding the discovery and initial use of ether anaesthesia illustrate these rivalries. The effects of these opinions and attitudes on the spread of ether anaesthesia are analyzed.
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To help decide when an inhalational agent should be discontinued during cardiopulmonary bypass (CPB), its rate of washin and washout must be known. Isoflurane one per cent was administered to 14 patients undergoing CPB and isoflurane blood concentrations were measured to determine the time course of washin and washout of this agent. Bubble oxygenators were used for seven patients and membrane oxygenators for the remaining seven. ⋯ Within 15 minutes of turning off the vaporizer only 25 per cent of the original blood concentration of isoflurane will remain. The anaesthetist must decide what concentration of isoflurane is acceptable during separation from CPB. Knowledge of the time course of isoflurane washout will allow more accurate determination of when to discontinue its administration in order to reach an acceptable concentration by the time separation from CPB occurs.
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Comparative Study
Regional anaesthesia for 12,000 cataract extraction and intraocular lens implantation procedures.
Twelve thousand regional anaesthetics for cataract extraction and intraocular lens implantation surgery were administered by one anaesthetist over a period of 52 months in a free-standing outpatient surgical facility. The ophthalmologist, who did all the operations, assessed the quality of the blocks using an objective scoring system which is described. The first 3,595 patients had retrobulbar and seventh nerve blocks. ⋯ A final group of 1,061 had a combination of peribulbar and periorbital blocks with added retrobulbar injection if indicated. As the method of blocking evolved, the more closely was the goal of safe, painless and effective regional anaesthesia approached. The requirements for effective anaesthesia of this type are presented, the complications described and the importance of familiarity with the anatomy of the orbit and its contents stressed.