Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Clinical Trial Controlled Clinical Trial
Epidural fentanyl plus bupivacaine 0.125 per cent for labour: analgesic effects.
Ninety-five healthy nulliparous women, ASA physical status I-II with an uncomplicated pregnancy and single fetus in vertex position were given lumbar epidural analgesia. Patients in Group A (n = 35) received bupivacaine 0.125 per cent with epinephrine 1:800.000; Groups B (n = 30) and C (n = 30) received the same agents as Group A but with the addition to the initial dose of 50 or 100 micrograms of fentanyl respectively. ⋯ Only the addition of 100 micrograms of fentanyl improved significantly the quality of analgesia (43.3 per cent of excellent scores vs 6.6 per cent in Group B and 5.7 per cent in Group A). Addition of fentanyl did not affect the duration of labour, the method of delivery and the neonatal neurobehaviour scores.
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Case Reports
Atypical malignant hyperthermia with persistent hyperkalaemia during renal transplantation.
A 35-year-old 110 kg male developed marked hyperkalaemia, hyponatraemia, hypercapnia and hyperthermia during living-related renal transplantation under anaesthesia with oxygen-nitrous oxide, isoflurane and muscle relaxation with atracurium. This is the first report of successfully treated malignant hyperthermia triggered by isoflurane during renal transplantation with early appearance and persistent (to 12 hours after surgery) electrolyte abnormalities.
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Case Reports
Percutaneous transtracheal high frequency jet ventilation as an aid to difficult intubation.
A case is described where prophylactic high frequency jet ventilation through a percutaneous transtracheal cannula was performed. This guaranteed adequate ventilation of a patient who was known to be difficult to intubate, enabling a paralyzing dose of succinylcholine to be given and intubation to be performed safely in a well oxygenated patient scheduled for coronary artery bypass grafting.
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The perioperative records of 354 consecutive patients undergoing craniotomy for surgical treatment of intractable epilepsy performed with conscious-sedation analgesia were reviewed retrospectively. There was no perioperative morbidity or mortality identified which could be attributed to the anaesthetic technique. ⋯ Less frequent problems included excessive sedation (three per cent), "tight brain" (1.4 per cent) and local anaesthetic toxicity (two per cent). This study confirms that conscious-sedation analgesia provides suitable conditions for craniotomies when brain mapping is required.