Canadian Anaesthetists' Society journal
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Randomized Controlled Trial Clinical Trial
Anaesthetic considerations in percutaneous radiofrequency coagulation of the Gasserian ganglion.
This study determined the cardiovascular effects of percutaneous radiofrequency coagulation of the Gasserian ganglion, performed under neuroleptanalgesia and intermittent ultrashort-acting barbiturate anaesthesia. Twelve ASA physical status class II patients were studied. Highly significant increases in mean heart rate and arterial blood pressure followed the insertion of the cannula electrode into the Gasserian ganglion (p less than 0.001). ⋯ In addition to providing suitable operating conditions for both surgeons and patient, we should also be able to maintain normal and stable cardiovascular haemodynamics. Intravenous nitroglycerin used as an adjunct to light general anaesthesia safely maintained intraoperative normotension. It is also suggested that patients with coronary artery disease be adequately monitored and protected during the procedure.
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Gastric rupture following ventilation during cardiopulmonary resuscitation is a rare occurrence. We report two cases of documented gastric rupture plus two additional cases in which the clinical diagnosis of pneumoperitoneum was made and gastric rupture was assumed to be the mechanism. Review of the literature reveals the lesser curvature of the stomach to be the common site of rupture. This complication emphasizes the necessities of correct positioning of the jaw with mouth-to-mouth ventilation and careful assessment of air entry and chest movement following endotracheal intubation.
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A case report of fatal cardiac arrest following protamine reversal of systemic heparinization during vascular surgery is presented. Patients who have received protamine zinc insulin, NPH insulin, and those with previous exposure to protamine sulphate or allergy to fish are more likely to have a reaction to protamine. Protamine-induced hypotension can be mediated by immunological or non-immunological mechanisms. Several alternative methods of heparin reversal which may avoid similar catastrophes are presented.