Canadian Anaesthetists' Society journal
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The volume of carbon dioxide rebreathed by spontaneously breathing patients under halothane anaesthesia at various fresh gas flow rates (FGF) with the Bain modification of the Mapleson "D" breathing circuit is measured. The effect of rebreathing on a heterogeneous patient population is shown to be unpredictable hypercapnia in those patients who cannot respond adequately to this carbon dioxide challenge. All adults rebreathe significant volumes of carbon dioxide at a FGF rate of 100 ml . kg-1 . min-1. ⋯ Rebreathing occurs because the inspired carbon dioxide load is unpredictable in a given patient and the patient's response is uncontrolled. Patients respond to this carbon dioxide challenge by increasing inspiratory flow rate (Vt/Ti), which results in increased rebreathing of carbon dioxide from the expiratory limb of the circuit. To prevent potentially dangerous rebreathing of carbon dioxide in all patients the fresh gas flow rate must be much higher than presently recommended.
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This paper reports the case of a 2 1/2-year-old male who appeared to have drowned in the family swimming pool. Immediate continuous cardiopulmonary resuscitation eventually restored circulation and respiration. ⋯ Prompt and continuous use of measures to support cerebral resuscitation were successful and the child subsequently was completely normal. A reevaluation of current information seems indicated in regard to the prognosis of the near-drowned child.
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Comparative Study
Experimental evaluation of local anaesthetic solutions using rat infraorbital nerve block.
The analgesic effectiveness of various local anaesthetic solutions was measured in the distribution of the infraorbital nerve of the rat. Using Sprague-Dawley rats sedated with phenobarbitone 25 mg/kg intraperitoneally and a simple stereotactic technique, 0.2 ml of solution was deposited at the infraorbital notch. The onset and duration of analgesia were ascertained by timing the unilateral absence of aversive response to pinching the upper lip, tested at intervals of five minutes. ⋯ Solutions were tested on sets of eight animals weighing 500--600 g. The average duration (minutes +/- S. D.) of analgesia produced by the respective injectates was as follows: Lidocaine 0.5% -42+/-12 Lidocaine 1.0% -47+/-10 Mepivacaine 0.5% -58+/-13 Mepivacaine 1.0% -78+/-23 Procaine 0.5% -0+/-0 Procaine 1.0% -34+/-10 Procaine 1.5% -46+/-13 2-Chloroprocaine 1.5% -38+/-9 Bupivacaine 0.5% -100+/-40 Etidocaine 1.0% -59+/-25 Tetracaine 0.2% -0+/-0 Tetracaine 0.3% -0+/-0 Comparison with other animal models used to evaluate conduction block indicates that this technique affords an improved, standardized and reliable experimental guide to the clinical analgesic properties of local anaesthetic agents.
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Comparative Study
Porcine malignant hyperthermia--failure of dantrolene dose response to diagnose susceptibility (halothane effect).
Dantrolene, a skeletal muscle relaxant, has been proven prophylactic and therapeutic for malignant hyperthermia (MH) in swine. This study examined the feasibility of using a dantrolene dose response as measured by indirectly evoked foretoe twitch depression as a means to safely discriminate MH susceptibility in swine. The effect of halothane on the dantrolene response was quantified. ⋯ Under halothane, the MHS animals had significantly augmented dantrolene response compared to MHR pigs, but three MHS animals had developed the MH syndrome prior to receiving dantrolene. We conclude that dantrolene muscle relaxant dose response cannot be used as a diagnostic test for MHS in swine. Halothane augments dantrolene twitch depression in MHS swine.
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Medical students should learn certain facts and comprehension of these facts during an elective month spent in a Department of Anaesthesia. This enables them to make the most of the tutorial situation in which they work with clinical anaesthetists. ⋯ They were associated with an improvement in student performance and were acceptable to students and instructors. However, computer based instruction should only be used to improve certain learning situations and should not be employed as an alternative to interaction with physicians and patients.