Canadian Anaesthetists' Society journal
-
The anaesthetic management of cardiopulmonary bypass (CPB) for a patient with biopsy-proven malignant hyperthermia is reported. Specific changes in the technique used, such as venting the oxygenator before use, monitoring mixed venous PO2 and PCO2, as well as the safety of cold hyperkalaemic cardioplegia are described. ⋯ We chose to treat left ventricular dysfunction by aggressive vasodilator (nitroglycerine) therapy. We detected no myocardial or respiratory depression secondary to dantrolene therapy either before or after operation.
-
Linear airway dimensions from incisor teeth to vocal cords were measured from radiographs. Normal children were slightly taller and heavier than children being treated for cleft palate and had significantly longer upper airway dimensions. ⋯ Data from normal children in these two studies were used to calculate the distance from lips to mid-trachea to determine optimal length for a tracheal tube. Previously published data on airway lengths in children are reviewed.
-
The characteristics of the neuromuscular block produced by prolonged succinylcholine infusion were compared in 40 patients anaesthetized with either nitrous oxide with enflurane (1-2 per cent inspired) or nitrous oxide and fentanyl. Neuromuscular transmission was monitored using train-of-four stimulation and the infusion rate was adjusted to keep the first twitch at 10-15 per cent of its control value. Initially, all patients, exhibited a depolarizing-type block all twitches of the train-of-four being roughly the same size, and the infusion rates were similar in the enflurane (54 microgram X kg-1/min) and the fentanyl (58 microgram X kg-1/min) groups. ⋯ Ten minutes after stopping the infusion fourth to first twitch ratios failed to reach 50 per cent in most patients given enflurane who had received more than 6 mg X kg-1 succinylcholine over more than 90 minutes. Corresponding figures for fentanyl patients were 13 mg x kg-1 and 150 minutes. The block in all 15 patients (9 enflurane, 6 fentanyl) who did not recover spontaneously was successfully antagonized with atropine and neostigmine.
-
The question posed for this study was: "While holding a watching brief during an uneventful intra-abdominal surgical procedure do anaesthetics adopt the same position in the operating room with reference to the patient's head and "anaesthetic machine" and, if they do, what is it?" A study of the relative positions of the patient, the anaesthetist, and the "anaesthetic machine" during routine laparotomy showed great variation. The implication was that there was also great variation in the amount of movement necessary by the anaesthetist if the same amount of information was to be obtained with the same frequency. The significance of this with reference to the quality of patient care is discussed. The role of changes in apparatus and the declared need for this by anaesthetics is mentioned and recommendations regarding the visual acquisition of data during anaesthesia are made.