Canadian Anaesthetists' Society journal
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This discussion is based on the experience of the Phoenix Surgicenter, where over 60,000 patients have been anaesthetized since 1970. Patients accepted for out-patient surgery are ASA Status I or II, although status III patients may be included if their co-existing disability is under excellent control. Eighty-five per cent of adult patients receive general anaesthesia. ⋯ Efforts during recovery are directed towards preparing the patient for discharge in a "home ready" condition for safe handling by attending relatives. The common complications have been postoperative nausea or emesis and hypotension. The hospital transfer rate has been 0.2 per cent.
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To examine a possible mechanism which could cause arterial hypoxaemia following pulmonary embolism, we collapsed and did not ventilate one lung in each of eleven dogs, to produce hypoxic pulmonary vasoconstriction. In five dogs (Starch Group), PaO2 fell from 10 to 7.7 kPa (76.6 to 58.4 torr) as shunt fraction (Qs/Qt) rose from 19 to 31 per cent. Mean pulmonary artery pressure (ppa), paCO2 and VD/VT remained constant. ⋯ We conclude from these results that emboli are preferentially distributed to ventilated lung. After embolization PPA increases. At least in this pulmonary embolism model the increased PPA may overcome hypoxic pulmonary vasoconstriction, redistribute blood to non-ventilated lung and create arterial hypoxaemia.
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Sensory profiles of lumbar epidural anaesthesia were studied in 57 patients, during active labour. The local anaesthetics used were chloroprocaine three per cent with and without epinephrine, chloroprocaine two per cent, bupivacaine 0.25 per cent and a mixture of chloroprocaine three per cent and bupivacaine 0.5 per cent. ⋯ Inguinal and suprapubic discomfort ("missing segment") occurred when S1 was not blocked. Under the conditions of this experiment, the addition of bupivacaine to chloroprocaine did not increase the duration of the blockade significantly.