Canadian Anaesthetists' Society journal
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Biography Historical Article
Charles Waterton (1782-1865): curare and a Canadian National Park.
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Twenty five adults and children with fractured shaft of femur were given femoral nerve block for pain relief. The block was found to be useful for purposes of transportation and immobilization. The pain relief was complete if the fracture site was in the middle third of the femoral shaft. The block is easy, safe, economical and most useful in emergency and poor risk patients.
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Comparative Study
A comparison of T4 and T7 dermatomal levels of analgesia for caesarean section using the lumbar epidural technique.
We compared analgesia to the T4 dermatomal level with analgesia to the T7 level with and without prophylactic intramuscular administration of ephedrine 25 mg to determine the adequacy and side effects of such analgesia for caesarean section. Unmedicated patients were prehydrated (727 +/- 303 ml of saline solution) and kept in a left lateral tilt position. Sufficient three per cent chloroprocaine was given to obtain analgesia to the T7 (T6-T8) dermatomal level (455 +/- 128 mg) or to the T4 (T3-T5) dermatomal level (758 +/- 168 mg). ⋯ Intramuscular administration of ephedrine 25 mg was not associated with increased plasma levels of norepinephrine, epinephrine or dopamine. There was no difference in Apgar score, behavioural test scores, neonatal acid-base status or oxygenation in children of mothers in the different groups. We conclude that a T4 dermatomal level of analgesia combined with intramuscular administration of ephedrine 25 mg, provides more maternal comfort than a T7 level of analgesia does, with or without ephedrine, and is without significant maternal or foetal side effects.
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A case is reported in which a young man undergoing exploratory thoracotomy following a gunshot wound had a cardiac arrest during reinflation of the collapsed lung. Systemic air embolism was suspected as the cause. ⋯ Discontinuation of nitrous oxide, aspiration of left heart chambers and a head-down position are recommended as immediate treatment if this diagnosis is made. In cases with piercing lung trauma high inflation pressures should be avoided to prevent embolism.