Canadian Anaesthetists' Society journal
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Pulmonary gas exchange is disturbed during general anaesthesia; both oxygenation and elimination of carbon dioxide are impaired. The shape of the chest wall alters after induction of anaesthesia-paralysis in recumbent subjects, and its motion during inspiration is also altered. The mechanical properties of lung and chest wall are also affected and FRC may be reduced. ⋯ These regions may progress into right-to-left shung during 100 per cent oxygen breathing. The low ventilation-to-perfusion regions and the shunt may both impair oxygenation. The development of lung regions with high ventilation-to-perfusion ratios after induction of anaesthesia-paralysis contributes to the inefficient elimination of carbon dioxide.
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A therapeutic and prophylactic dose of dantrolene administered to malignant hyperthermia-susceptible pigs had no effect on the abnormal in vitro contracture response of subsequent muscle biopsies. The in vitro contracture response of MHS pig muscle to halothane and to caffeine was not altered by prior dantrolene treatment. It is concluded that prior dantrolene administration has no effect on the discrimination of porcine MSH by in vitro pharmacological testing.
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A case of accidental hypothermia is reported. This patient was rewarmed by using a peritoneal irrigation. ⋯ Peritoneal irrigation constitutes a fast and effective technique of core body rewarming in cases of moderate or severe hypothermia. Another advantage of this method is that it can be accomplished without complicated equipment and that it can be used even in small community hospitals.
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Review Case Reports
Awareness, muscle relaxants and balanced anaesthesia.
The incidence of awareness during insufficient anaesthesia is reported to be one per cent. It is usually due to the use of muscle relaxants, a balanced technique and the lightest possible depth of anaesthesia. Increased incidences were noted in open-heart surgery, during intubation-endoscopy procedures and in caesarean delivery patients. ⋯ Fourteen representative cases of the problem are reported. Since no adequate sign or test exists for detection of awareness during very light anaesthesia or with associated paralysis, more meticulous attention is required in using relaxants or the balanced technique. Greater anaesthetic supplementation and reduction in the use of relaxants are recommended to halt the recurrence of this most serious anaesthetic problem.