Canadian Anaesthetists' Society journal
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During general anaesthesia with oxygen, nitrous oxide and enflurane, a 29-year-old woman received a total of 105 mg (1.78 mg X k-1) of atracurium over a 2.5 hour period. The neuromuscular blockade could not be completely reversed with neostigmine and mechanical ventilatory support was necessary for three hours postoperatively. The patient received succinylcholine without unusual sequelae before and after this episode. This is the first report of a patient who exhibited prolonged weakness after receiving atracurium.
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To determine the optimal interval between the administration of the priming dose and the intubating dose, atracurium was given to 44 patients either in a single dose of 0.5 mg X kg-1 or in an initial dose of 0.06 mg X kg-1 followed two, three or five minutes later with 0.44 mg X kg-1. When atracurium was given as a single bolus of 0.5 mg X kg-1 the time to 100 per cent twitch suppression (onset time) was 90.9 +/- 36 (mean +/- SD) seconds. When the priming interval was two minutes, the onset time of the intubating dose was 76.6 +/- 42.2 seconds (p = NS). ⋯ Waiting for five minutes after the administration of the priming dose did not improve the intubating conditions. It is concluded that three minutes appears to be the optimal time interval for the administration of atracurium in divided doses. When a priming dose of atracurium is given three minutes before the intubating dose, it can provide an alternative to succinylcholine for rapid endotracheal intubation.
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Hospitals and anaesthetists in British Columbia were surveyed by means of questionnaires to assess patterns of obstetric anaesthesia practice, qualifications and numbers of obstetric anaesthesia personnel, hospital obstetric facilities and facilities and protocols for neonatal resuscitation. It was apparent that a large proportion of the obstetric anaesthesia service in this province was being provided by physicians who were not trained, nor certified, as anaesthesia specialists. Preanaesthetic assessment in the obstetric units differed in attitude and practice from the standards expected in the general operating rooms. ⋯ Post-anaesthetic recovery facilities in obstetric units were conspicuously deficient, even in the larger hospitals. The majority of community hospitals lacked written protocols for neonatal resuscitation; and the number of institutions reporting that the neonatal heart rates and temperatures were not routinely monitored is of concern. It is recommended that minimum standards for training in obstetric anaesthesia should be clearly defined; and provision should be made for revision and upgrading of knowledge and skills for physicians practicing anaesthesia in smaller community hospitals.
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Oesophageal perforation, due to a difficult endotracheal or nasogastric intubation occurred in a 49-year-old female. Perforation of the oesophagus is a rare complication of intubation of the trachea or oesophagus. Endotracheal intubation alone is most often blamed for iatrogenic oesophageal trauma following surgery. ⋯ Plain roentenograms of the neck and a contrast media swallow will confirm the diagnosis. Treatment consists of massive antibiotic therapy followed by surgical repair and drainage of the area. Mortality ranges from 10-15 per cent with early diagnosis to 50 per cent if surgery is delayed.