Canadian Anaesthetists' Society journal
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Review Comparative Study
Newborn anaesthesia: pharmacological considerations.
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An overall management plan for malignant hyperthermia susceptible (MHS) parturients is presented based on the experience of managing 14 of these patients. A summary of the pertinent features of their deliveries and care plus a case report of one of these parturients is described. Discussion centres around the problems of diagnosis of malignant hyperthermia susceptibility in pregnancy, the differential diagnosis and management of fever and tachycardia in a MHS parturient during labour and the use of dantrolene prophylaxis. ⋯ The importance of being prepared for a potential crisis is stressed with particular emphasis on early diagnosis by monitoring of temperature at two sites, of heart rate and rhythm with a continuous ECG and of end-tidal carbon dioxide, should a general anaesthetic be required. Recommendations are made for appropriate anaesthetic agents for both regional and general anaesthesia. Treatment of a MH crisis is outlined, with emphasis on availability of appropriate resuscitative drugs.
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Large-volume low-pressure cuffs have been introduced in an endeavour to reduce the incidence of tracheal mucosal damage. These cuffs when inflated to clinical seal develop folds, which together with low clinical seal pressure may not protect against aspiration. ⋯ The incidence of dye tracking past the large-volume cuffs studies was 100 per cent whereas no aspiration of dye was seen past the red rubber tubes. Increasing cuff pressure in the large-volume cuffs beyond clinical seal to 50 cm H2O did not obliterate the dye-filled cuff folds, despite wide variation in the thickness of the cuff material.