Canadian Anaesthetists' Society journal
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Out-patient surgery for infants and children offers the advantages of minimal emotional upset, less risk of infection, and fiscal economy. Many different operations can be done in the out-patient department and most children can be accepted for general anaesthesia for these operations. Preparation of the child is similar to that required for in-patient surgery. ⋯ Careful tracheal intubation should be utilized whenever indicated. Regional analgesia has many advantages over narcotic analgesics in the treatment of post-operative pain. A follow-up service should be provided.
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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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The authors reviewed the records of seventy preterm infants suffering from respiratory distress syndrome and, in most cases, refractory congestive heart failure, who underwent ligation of patent ductus arteriosus. The peri-operative management of these patients is described. The anaesthetic technique consisted of nitrous oxide and oxygen supplemented with a relaxant. ⋯ The infants were protected from significant temperature fluctuations by various methods which are described. The overall survival rate of all preterm infants with respiratory distress syndrome. The management presented is considered acceptable to the infants, to the surgeons and to the anaesthetists.
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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.