Canadian Anaesthetists' Society journal
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Case Reports
Acute febrile reaction complicating spinal anaesthesia in a survivor of malignant hyperthermia.
A case report is presented of a survivor of malignant hyperthermia who suffered an acute febrile episode during the course of a spinal anaesthetic. It is suggested that the extreme degree of intra-operative anxiety may have triggered this event.
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The feasibility of using computer-based EEG spectral analysis to monitor the level of anaesthesia during nitrous oxide-alphaprodine anaesthesia has been established by this study. At present, this system is capable of estimating the level of anaesthesia correctly from 55 per cent to 80 per cent of the time. There are several possible clinical applications of such a monitoring system during anaesthesia. ⋯ This system can also be of particular benefit during anaesthesia for critically ill patients, or in specific cases, as in neurosurgery and caesarian section when there may be periods of time when the gross clinical evaluation of depth of anaesthesia may not be precise or reliable and yet it is imperative not to deepen the anaesthesia unnecessarily. In such instances it appears that a monitoring system such as we have developed could provide valuable indication of the depth of anaesthesia. Other potential applications might be in the training of students in the clinical assessment of patients during anaesthesia and in the study of new anaesthetic agents.
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Randomized Controlled Trial Clinical Trial
Lorazepam as a premedication.
A double-blind random study compared the effects of lorazepam and pantopon an intra-muscular premedication in healthy women for uterine curettage (D & C). Anxiety, as assessed by a self-rating test by the patient and by a trained observer, showed a significant reduction at one and one-half hours after lorazepam and a smaller reduction after pantopon, which was not significant. Sedation was satisfactory with no significant difference between the two drugs in the change before and after the premedication. ⋯ The results of this study show that lorazepam produces better reduction of anxiety and much more amnesia than pantopon, with comparable sedation and much less nausea and vomiting. The only disadvantage of lorazepam is the lack of analgesia and, therefore, the need for more anaesthesia during the operation. The conclusion is that lorazepam is a very satisfactory premedication and warrants more use as such.
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Closing capacity (CC; the lung volume at which dependent lung zones cease to ventilate, presumably as a result of airway closure) and standard lung volumes were measured in twenty-four normal women 21 to 29 years of age in the seated and supine positions. Measurements were made serially during pregnancy and once 6 to 8 weeks post partum (the control period). ⋯ FRC-CC was reduced in the supine position as compared to seated. The reduced FRC-CC during pregnancy offers a potential explanation for the observations of abnormally low arterial oxygen tensions (Pao2) during pregnancy in some women, and of reduced Pao2 in pregnant women in the supine as compared to upright position.
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Comparative Study Clinical Trial Controlled Clinical Trial
Althesin and thiopentone: a clinical comparison.
Althesin was compared with thiopentone in a double blind study of 200 patients undergoing gynaecological operations. Althesin in a dose of 0.05 ml/kg was found to be an excellent induction agent, virtually devoid of undesirable side effects; however, when used as the principal anaesthetic (supplemented only by 66 per cent nitrous oxide in oxygen), the incidence of disturbing movements was high. Recovery time from Althesin was one-third of that after thiopentone. The patients recovering from Althesin were remarkably clearheaded with a low incidence of "hangover".