Journal of clinical anesthesia
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Much has been written about Canada's health care system as all countries wrestle with rising health costs. Few, however, have attempted to describe the influence of a system of health care on a nonprimary care specialty such as anesthesia. The purpose of this review is to describe the Canadian system, contrast it with that of the United States, and outline the impact that Canadian Medicare has had on anesthetic practice. ⋯ Each provincial medical association is responsible for negotiating the fee schedules with the provinces on behalf of its members. Since these associations must respond to the majority of their members, it has been the perception of specialty groups such as anesthesia that the emphasis of allocations in recent years has been on primary care fields. Anesthetists have therefore found themselves increasingly involved with the collective negotiation process as an unwanted necessity of practice.(ABSTRACT TRUNCATED AT 400 WORDS)
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Aneurysmal rupture represents the most common cause of subarachnoid hemorrhage. Approximately two-thirds of persons who experience a subarachnoid hemorrhage will die or become disabled. ⋯ The anesthetic management of these patients is reviewed, emphasizing principles relating to the facilitation of surgery--by optimizing operative conditions and minimizing the risks of intraoperative aneurysmal rupture or the aggravation of neurologic deficits--and to the provision of a smooth, stable recovery. Despite the disappointing overall prognosis following subarachnoid hemorrhage, adherence to these principles can optimize the outcome for those patients who reach the operating room.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative effects of desflurane and isoflurane on vecuronium-induced neuromuscular blockade.
To evaluate the neuromuscular effects of a nondepolarizing muscle relaxant (vecuronium) during anesthesia with equipotent concentrations of either desflurane or isoflurane. ⋯ Vecuronium has similar neuromuscular effects when administered in the presence of desflurane 3% and isoflurane 0.6%.
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Randomized Controlled Trial Clinical Trial
The effect of an intermediate dose of labetalol on heart rate and blood pressure responses to laryngoscopy and intubation.
To evaluate the efficacy of an intermediate dose of labetalol (0.4 mg/kg) for attenuation of heart rate (HR) and blood pressure (BP) responses to laryngoscopy and intubation. ⋯ An intermediate dose of labetalol blunted the HR response to laryngoscopy and intubation during rapid-sequence induction in healthy patients but had a minimal effect on BP.
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A jet stylet is a small internal diameter (ID), semirigid hollow catheter that is inserted into an in situ tracheal tube prior to extubation of a patient who may be difficult to reintubate. After the tracheal tube is withdrawn over the jet stylet, the hollow catheter can be used for jet ventilation or as an intratracheal stylet for reintubation with a new tracheal tube. It was previously thought that after the new tracheal tube was inserted over the jet stylet, the stylet would have to be removed to allow connection of the new tube to the breathing circuit and confirmation of intratracheal placement of the tube. We describe a method for preserving the intratracheal location of the jet stylet while confirming intratracheal placement of the new tracheal tube.