Canadian Anaesthetists' Society journal
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We studied the relationship between arterial carbon dioxide tension (PaCO2) and fresh gas flow (FGF) during use of the Bain breathing circuit for Caesarean section anaesthesia. Thirty-one patients undergoing Caesarean section were anaesthetised using the Bain circuit with intermittent positive pressure ventilation. ⋯ This is probably because the total FGF determined by body weight and given during Caesarean section anaesthesia is 15-20 per cent higher than nonpregnant levels, due to the weight gain associated with pregnancy. A FGF of 100 ml X kg-1 of pregnant weight/min maintains PaCO2 of 4.44 kPa predelivery, which is in the desirable range of PaCO2 during Caesarean section.
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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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The case histories are presented including the anaesthetic and postoperative management, of two children, a two-year-old with undiagnosed Duchenne muscular dystrophy (DMD) and a three-year-old with known DMD. The child with undiagnosed DMD had no symptoms of DMD and had received halothane twice before, without succinylcholine, with no apparent difficulty. Following an uneventful induction of anaesthesia with halothane, nitrous oxide and O2, succinylcholine resulted in bilateral masseter muscle spasm and then, in rapid sequence, ventricular tachycardia and cardiac arrest. ⋯ Postoperatively his temperature rapidly increased to 38.8 degrees C and then 40.3 degrees C and he became metabolically acidotic. Intravenous administration of dantrolene for 48 hours reduced the temperature and allowed normal recovery and discharge. A postoperative muscle biopsy was consistent with DMD.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.