Canadian Anaesthetists' Society journal
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The fiberoptic laryngoscope can make difficult or impossible tracheal intubation as easy as a routine procedure. Although this instrument has been available for many years it has never achieved the popularity it deserves because anaesthetists have abandoned it after a few unsuccessful attempts to use it. Detailed procedure for the successful use of this instrument and the reasons for failure are described. Facility with the instrument should be developed by practice with patients where no difficulty in intubation is anticipated rather than making first attempts when problems arise.
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The recent literature still reports a high incidence of delirium in patients operated with extracorporeal circulation. This syndrome is found more often in patients over 50 years and in patients with a previous history of delirium, alcoholism, drug addiction or cerebral damage and is more frequent after valvular than after coronary surgery. It is also often observed in patients who present major post-operative complications. ⋯ Major post-operative complications were found in 37 (44 per cent) of these 84 patients. The incidence was lower (1.45 per cent) in coronary than in valvular (4.6 per cent) surgery cases. Several explanations are presented to explain this low incidence.
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A case of excessive heparin requirement during cardiopulmonary bypass is reported. A patient with sepsis secondary to a myocardial abscess require 13.5 mg x kg-1 of heparin to increase his activated coagulation time to a therapeutic level. This phenomenon might be due to individual variability, lupus vasculitis, septicaemia, repeated thromboembolic phenomenon with hypercoagulable state, or chronic disseminated intravascular coagulation with partial antithrombin deficiency.