Canadian Anaesthetists' Society journal
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We have studied 22 consecutive cases of posterior cervical osteotomy done at the Toronto East General Hospital between October 1967 and November 1973. The anaesthetic management is discussed in some detail and consists of psychological preparation of the patient, and neuroleptanalgesia with infiltration with local anaesthetic by the surgeon. ⋯ One patient died three weeks post-operatively of pulmonary embolism. Experience in anaesthetizing patients who require operation after previous posterior cervical osteotomy is mentioned briefly and techniques are recommended for successful management of such cases.
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Two case reports, one a vaginal delivery, the other a Caesarean Section, have been presented to demonstrate the rationale of employing a chloroprocaine-bupivacaine sequence for extradural analgesia in obstetrics. Use of chloroprocaine for initiation and bupivacaine for maintenance of the block offers at least three advantages: (1) onset of pain relief is prompt while duration is prolonged; (2) more than one "test" dose of chloroprocaine may be employed with safety in rapid succession; (3) two drugs with different metabolic patterns are used, each in reduced amount.
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Based on measurements of arterial CO2 tension in 132 adult patients, a curve was constructed relating fresh gas inflow and arterial CO2 tension for a modified Mapleson D system. In patients on controlled ventilation using a ventilating volume greater than the predicted respiratory minute volume, it was found that the arterial Pco2 can be predicted from the fresh gas inflow with an accuracy sufficient to be clinically useful.
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Substitutes for whole blood include blood fractions such as plasma, serum albumin and other fluids of various kinds which are not derived from blood but are used as plasma volume expanders; these, include the usual crystaloid intravenous solutions. Since in comparison to blood far more of these later solutions are given intravenously, a thorough knowledge of plasma volume expanders is essential. The first use of such expanders in human patients was by Hogan in 1915. ⋯ They are inexpensive and readily available, and do not transmit the virus of hepatitis. In large amounts they cause a coagulation defect and may be antigenic. Continued.
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Comparative Study
Concentration of lidocaine hydrochloride in newborn gastric fluid after elective caesarean section and vaginal delivery with epidural analgesia.
Lidocaine concentrations were measured after vaginal delivery or Caesarean section with epidural anaesthesia in samples of maternal and umbilical blood and in newborn gastric contents. The pH of the gastric aspirate was also determined in a number of neonates. ⋯ A significant inverse correlation exists between gastric pH and gastric lidocaine concentration, Neonate gastric lidocaine concentration was significantly higher than in maternal or umbilical venous plasma after vaginal delivery, but not after Caesarean section. Due to these differences, gastric lavage for the treatment of neonatal lidocaine intoxication may be more beneficial in reducing foetal systemic local anaesthetic concentration after vaginal than after elective abdominal delivery.