Canadian Anaesthetists' Society journal
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Effects on haemodynamics and myocardial oxygenation of endotracheal intubation were examined in 17 patients after halothane induction and 12 after 1 mg X kg-1 of IV morphine. Six patients having each anaesthetic were pretreated with IV propranolol (0.1 mg X kg-1) 45 minutes earlier. Arterial and intracardiac pressures, cardiac output and total coronary sinus blood flow (CSBF), both by thermodilution, were determined plus arterial-coronary differences of oxygen, haemoglobin and lactate. ⋯ More myocardial oxygen was extracted and consumed after intubation, but lactate extraction continued: these data are evidence of adequate oxygen supply. Induction with either halothane or morphine effectively prevented the hypertensive response to intubation. Acute beta blockade led to less increase in heart rate from intubation.
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We describe a new catheter for emergency ventilation of patients difficult to intubate. This catheter can be inserted through the crico-thyroid membrane or the first or second intertracheal ringspace with ease in an almost atraumatic fashion. ⋯ A Velcro band attached to two lateral flanges keeps the catheter in place. The results of transtracheal catheterization of 48 patients by means of this new device are discussed.
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Protamine administration may induce arterial hypoxaemia in dogs and humans. However, the responsible mechanism has not been established. Protamine, as it is a pulmonary vasoactive substance, may interfere with normal hypoxic pulmonary vasoconstriction (HPV) and cause arterial hypoxaemia. ⋯ Our results demonstrate that protamine interferes with effectiveness of pre-existing HPV and suggest that this mechanism, at least in part, may be responsible for arterial hypoxaemia observed after protamine infusion. The marked generalized pulmonary vasoconstriction with protamine appears to be the direct force that interferes with pre-existing auto-regulatory HPV. In addition to the well known haemodynamic effects of protamine, protamine infusion may also cause arterial hypoxaemia in those patients in whom HPV plays a significant role in maintaining arterial oxygenation.
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A two-year-old female child status post-bilateral nephrectomies sustained a cardiac arrest following the central intravenous administration of vancomycin chloride. This report reviews the literature concerning the problems associated with the use of vancomycin chloride in the perioperative period.
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The effect of halothane and enflurane on changes in heart rate during reversal of neuromuscular blockade was compared in 48 patients. Premedication and anaesthetic technique was standardized. Either halothane or enflurane was used as the primary anaesthetic. ⋯ Heart rate changes were significantly different between the halothane and enflurane subgroups. Patients anaesthetized with enflurane showed less fluctuations in heart rate. Simultaneous injection of glycopyrrolate and neostigmine minimized the tachycardia in the halothane subgroups only.