Canadian Anaesthetists' Society journal
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Neuromuscular blockade during surgery was provided with vecuronium in 24 adult patients in end-stage renal failure and in 21 normal patients who served as controls. Dose response curves were constructed which showed that the effective doses required to produce 50, 90 and 95 per cent neuromuscular blockade in patients with renal failure were 27.5, 43 and 49 micrograms X kg-1 respectively. ⋯ Recovery from the block occurred rapidly after neostigmine, was no different in renal failure and was not associated with recurarization. It is concluded that, when given to subjects in renal failure, vecuronium offers advantages over established agents such as shorter duration of action and easy reversibility.
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A 32-year-old female was admitted for a minor elective surgical procedure. Her past history included at least six uneventful general anaesthetics. Anaphylaxis developed shortly following induction of anaesthesia with thiopentone, Innovar and gallamine. ⋯ Full recovery followed. Subsequent allergy skin tests revealed hypersensitivity to thiopentone. Recommendations for investigation of suspected hypersensitivity to anaesthetic agents are included, as are guidelines for the recognition and treatment of anaphylaxis.
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Pregnancy is rarely associated with Cushing's syndrome. This case report describes the successful management of a Caesarean section under epidural anaesthesia in a patient with Cushing's syndrome. Maternal and fetal complications are reviewed from an anaesthetic perspective and alternative anaesthetic techniques discussed.
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A pregnant patient at 38 weeks gestation presented for a combined procedure of Caesarean section, tubal ligation and cerebral aneurysm clipping. Anaesthesia was induced with thiopental, succinylcholine was administered to facilitate tracheal intubation, and intravenous lidocaine and sodium nitroprusside were used to reduce the hypertensive response to tracheal intubation. ⋯ Following completion of the surgical procedures, the patient promptly emerged from anaesthesia and was neurologically normal in the operating room. It is concluded that general anaesthesia can be used satisfactorily for a combined procedure of Caesarean section and cerebral aneurysm clipping.
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A case history is presented of a three-year-old boy with unsuspected Duchenne muscular dystrophy, who suffered a cardiac arrest following the administration of a single dose of succinylcholine during a halothane anaesthetic. The arrest was associated with lack of fasciculations, muscle rigidity, hyperkalemia, myoglobinuria, and massive elevation of serum creatine phosphokinase. ⋯ The possible cause of the circulatory collapse is discussed and reports of similar cases reviewed. Neither succinylcholine nor halothane should be employed in cases with known or suspected Duchenne muscular dystrophy.