Canadian Anaesthetists' Society journal
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A young healthy male, who had three consecutive episodes of postoperative hyperthermia was anaesthetized with special precautions to prevent malignant hyperthermia. Despite neuroleptic anaesthesia and dantrolene pretreatment, the patient experienced post-anaesthetic hyperthermia. ⋯ The serum potassium (K) and creatinine phosphokinase (CPK) levels determined during the hyperthermic episode and on the next day were not elevated. On the basis of the patient's family history, his clinical picture, and his laboratory data, we speculate that this patient might have a form of malignant hyperthermia or a possible new variant.
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Eighteen mongrel dogs were randomized into two equal groups. Cervical, thoracic and lumbosacral spinal cord and spinal dural blood flows were measured using the radioactive microsphere technique. Blood flow determinations were made prior to, and 20 and 40 minutes following lumbar subarachnoid injection of: (1) 0.4 per cent bupivacaine (20 mg), or (2) 0.4 per cent bupivacaine (20 mg) with 1/25,000 epinephrine (200 micrograms). ⋯ Dogs receiving subarachnoid bupivacaine with epinephrine demonstrated a significant decrease in thoracic and lumbosacral spinal cord blood flow; however, cervical cord blood flow remained unchanged. Thoracic and lumbosacral dural blood flows were significantly decreased in both groups following subarachnoid injection. Subarachnoid bupivacaine 0.4 per cent (20 mg) and 0.4 per cent with epinephrine 1/25,000 (200 micrograms) decrease spinal cord and spinal dural blood flow in dogs.
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Sixty-four cases of posterior lumbar extension osteotomy performed at the Toronto East General Hospital between 1969 and 1983 are reviewed. The anaesthetic management is presented. The procedure was performed with local infiltration anaesthesia, heavy sedation and a brief period of general anaesthesia induced with nitrous oxide, halothane or ketamine. ⋯ A method of supporting these deformed patients in the prone position in moulded plaster casts is described. Anaesthetic and surgical complications and postoperative psychological disturbances are described and discussed. It is suggested that caudal epidural opioid or local anaesthetic analgesia be explored as an aid in the management of these patients.