Canadian journal of anaesthesia = Journal canadien d'anesthésie
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This report describes iatrogenic pneumocephalus in an obstetrical patient following attempted epidural anaesthesia using the loss of resistance technique. On the fourth attempt at epidural injection, an apparent loss of resistance was identified and 5 ml air was injected. ⋯ The baby was eventually delivered by Caesarean section, with general anaesthesia and avoiding nitrous oxide. The patient's headache resolved within 24 hr without further sequelae.
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Case Reports
Minitracheostomy in elective surgery of the larynx: an alternative to formal tracheostomy.
A patient scheduled for surgical removal of a giant polyp of the larynx, and in whom difficult orotracheal intubation was anticipated in the preoperative visit, was managed successfully with a minitracheostomy performed with a Mini-Trach II kit. The ventilation achieved was adequate throughout the procedure. Thus, conventional tracheostomy was avoided.
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Randomized Controlled Trial Clinical Trial
Epidural nalbuphine for analgesia following caesarean delivery: dose-response and effect of local anaesthetic choice.
The analgesic profile of epidural nalbuphine for postoperative pain relief and the impact of local anaesthetic choice upon this profile was investigated in 58 patients undergoing elective Caesarean delivery under epidural anaesthesia. Patients were randomized to receive either lidocaine 2% with 1:200,000 epinephrine or 2-chloroprocaine 3% for perioperative anaesthesia, followed by either 10, 20, or 30 mg of epidural nalbuphine administered at the first complaint of postoperative discomfort. Postoperative analgesia was quantitated on a visual analogue (VAS) scale, and by the time from the epidural opioid injection until the first request for supplemental pain medication. ⋯ No evidence of respiratory depression was noted in any patient. It is concluded that 20 or 30 mg of epidural nalbuphine provides analgesia for only two to four hours following Caesarean delivery with lidocaine anaesthesia, but anaesthesia with 2-chloroprocaine resulted in minimal or no analgesia from this opioid. Nalbuphine appears to be a disappointing agent for epidural use after Caesarean delivery.
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Continuous pulse oximetry was performed on 173 adults after general anaesthesia for elective inpatient surgery, throughout their post-anaesthesia care unit (PACU) stay. Supplemental oxygen was administered for greater than or equal to 30 min after arrival and subsequently discontinued before discharge to the ward. The mean and minimum oxyhaemoglobin saturation (SpO2) after discontinuing oxygen were lower than those values achieved during oxygen administration and preoperatively (P less than 0.001). ⋯ Factors associated with hypoxaemia were: ASA physical status class; surgical duration greater than or equal to 90 min; and preoperative mean SpO2 less than 95%. Factors not associated with hypoxaemia were: age, sex, % ideal body weight, smoking history, preoperative minimum SpO2, premedication and type of surgery. In conclusion, after discontinuing supplemental oxygen in the PACU, hypoxaemia was common, difficult to detect clinically, and associated with ASA class, surgical duration and preoperative mean SpO2.
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Review Case Reports
Horner's syndrome and trigeminal nerve palsy following epidural anaesthesia for obstetrics.
While Horner's syndrome is a rare but occasionally reported side-effect of epidural block administered for labour, trigeminal nerve palsy has been described only once. The cases described in this report confirmed the benign nature of these neurological complications of epidurally administered anaesthetics which were not detrimental to fetal viability. The complications may be attributed to extensive cephalad spread of local anaesthetic, sometimes via unexplained routes and with surprisingly selective targeting effect (unilateral trigeminal nerve palsy). The atypical and unusually high cephalad spread of local anaesthetic in pregnant women at term is believed to be due to pregnancy-related altered anatomy and physiology of the epidural space.