Canadian Anaesthetists' Society journal
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In general, the cardiovascular system is more resistant to the toxic actions of local anaesthetics than is the central nervous system. However, if sufficient doses and blood levels of local anaesthetics are achieved, signs of profound cardiovascular depression may be observed. Differences exist between local anaesthetics in terms of their relative potential for cardiotoxicity. ⋯ However, large dosages of chloroprocaine solutions administered intrathecally have been associated with prolonged sensory-motor deficits in a few patients due probably to the low pH and presence of sodium bisulfite in the chloroprocaine solutions. In general, the incidence of toxic reactions to local anaesthetic agents is extremely low. However, as with any class of pharmacological agents, local anaesthetics may cause severe toxic reactions, due usually to the improper use of these drugs.
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We present three patients with Treacher Collins or Pierre Robin syndromes who had historical and physical evidence of airway obstruction, difficulty feeding, and sleep disturbances. These preoperative findings correlated with difficult airway management intraoperatively. Based on this experience, we recommend that children with obstructive symptoms have laryngoscopy prior to anaesthetic induction. ⋯ After intubation, anaesthesia is best maintained with oxygen and a potent inhalational agent. Extubation should only be done with the patient fully awake and with emergency airway equipment immediately available. Postoperatively, these patients should be transferred to an intermediate care area or intensive care unit where they can be observed closely since delayed complications of airway obstruction are common in this group of patients.
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Oesophageal perforation, due to a difficult endotracheal or nasogastric intubation occurred in a 49-year-old female. Perforation of the oesophagus is a rare complication of intubation of the trachea or oesophagus. Endotracheal intubation alone is most often blamed for iatrogenic oesophageal trauma following surgery. ⋯ Plain roentenograms of the neck and a contrast media swallow will confirm the diagnosis. Treatment consists of massive antibiotic therapy followed by surgical repair and drainage of the area. Mortality ranges from 10-15 per cent with early diagnosis to 50 per cent if surgery is delayed.
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Lidocaine has been used in obstetrical anaesthesia for many years but there are still concerns about possible adverse affects of this drug on the foetus in utero. To examine in greater detail the effects of lidocaine in the foetus, the following two-part study was done. In Part A, seven pregnant ewes were surgically prepared with maternal and foetal arterial and venous catheters. ⋯ In the acidotic foetuses, lidocaine concentrations of 1.4-1.5 mg X ml-1 produced a tachycardia and an increase in cerebral blood flow compared to the control acidotic foetuses. There were no other significant changes. We conclude that arterial lidocaine concentrations of less than 3.5 mg X ml-1 do not produce significant alterations in organ blood flow in normal foetal lambs.(ABSTRACT TRUNCATED AT 250 WORDS)