Canadian Anaesthetists' Society journal
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The commonly used vasodilators sodium nitroprusside and nitroglycerin increase intracranial pressure (ICP) and cause tachycardia. Since diltiazem is also a vasodilator, we designed this experiment in cats to study its effect on intracranial pressure and heart rate (HR). Twelve cats were assigned to two equal groups. ⋯ Both groups received an infusion of diltiazem to decrease the mean blood pressure (BP), which was maintained 30 per cent below the baseline value for 15 minutes. Diltiazem caused no significant change in ICP (5.7 +/- 1 to 6.7 +/- 1.5 mmHg, p less than 0.01) in cats with N-ICP while in cats with AR-ICP, the increase from 26.9 +/- 0.5 to 34.0 +/- 1.9 mmHg was significant (p less than 0.006). HR decreased significantly during the diltiazem infusion in both groups.
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Clinical Trial Controlled Clinical Trial
Esmolol for control of increases in heart rate and blood pressure during tracheal intubation after thiopentone and succinylcholine.
Esmolol, an ultra-short-acting cardioselective beta-adrenergic blocker, was investigated in a double-blind prospective protocol for its ability to control haemodynamic responses associated with tracheal intubation after thiopentone and succinylcholine. Thirty ASA physical status I patients received a 12-minute infusion of esmolol (500 micrograms X kg-1 X min-1 for four minutes, then 300 micrograms X kg-1 X min-1 for 8 minutes) or saline. Five minutes after the start of the drug/placebo infusion, anaesthesia was induced with 4 mg X kg-1 thiopentone followed by succinylcholine for tracheal intubation. ⋯ Increases in HR, SAP and RPP after intubation were approximately 50 per cent less in patients given esmolol compared to patients given placebo. There were highly significant differences in HR (p less than 0.0001), and RPP (p less than 0.0005) and significant differences in SAP (p less than 0.05) when the maximal esmolol post-intubation response was compared to the maximal placebo response. Infusion of esmolol in the dose utilized in this study significantly attenuated but did not completely eliminate cardiovascular responses to intubation.
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Three cases of trismus caused by oropharyngeal sepsis are described where fibreoptic-assisted awake intubation using an oral airway intubator and nebulised lidocaine was safely and successfully achieved.
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A case report is presented describing the clinical usefulness of transcutaneous oxygen (PtcO2) monitoring in an infant undergoing tracheoesophageal fistula repair. Its use allowed early and precise recognition of hypoxaemia during periods of surgical manipulation. During periods of hypoxaemia, there were no associated cardiovascular changes or changes in routine monitoring modalities. Clinical use of PtcO2 may detect early hypoxaemia and thus allow for correction before the appearance of changes in vital signs.
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An episode of malignant hyperthermia occurring in a two-year-old child undergoing cardiac surgery is reported. The coincidental usage of hypothermic cardiopulmonary bypass obscured the classical presenting signs and symptoms of the syndrome. Once the clinical diagnosis was confirmed, rapid reversal was achieved with the administration of dantrolene sodium.