Canadian journal of anaesthesia = Journal canadien d'anesthésie
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In an attempt to define what factors are important to the development of postanaesthetic complications, the data from a nine-year prospective study of anaesthetic practice in a large tertiary care institution were evaluated. A model of anaesthetic morbidity dependent upon factors of patient illness, surgical practice, anaesthetic technique and physician experience, and duration of anaesthesia was developed. Postoperative anaesthetic morbidity was defined as any anaesthetic-related complication which, in the opinion of the follow-up nurse, was associated with prolonged hospitalization or documented compromise of the patient. ⋯ The duration of anaesthetic exposure was an important determinant of risk (odds ratio = 2.53), with complications increasing with the length of anaesthetic time. As to factors under control of the anaesthetist those patients experiencing operating room complications (odds ratio = 3.36) or those receiving pure spinal (odds ratio = 5.53) or narcotic techniques (odds ratio = 2.14) had higher risks of postoperative complications. Finally, it would appear that the greater the experience of the anaesthetist the less the risk of postoperative problems (odds ratio = 0.52).
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Lidocaine 0.5 per cent in a dose of 2 mg X kg-1 was used for intravenous regional analgesia with the tourniquet cuff placed over the forearm. The level of tourniquet cuff pressure employed was the arterial "occlusion pressure" plus 50 mmHg. ⋯ No toxic symptoms and signs were observed. Measurement of serum lidocaine concentrations in 12 patients confirmed the safety of the technique, although small leakage of lidocaine past the inflated forearm tourniquet was detected in some patients.