Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Major life-threatening complications following blood transfusion are rare and human error remains an important aetiological factor in many. The infectious risk from blood transfusion is predominantly hepatitis, and non-A, non-B and hepatitis C (HCV) are the most common subtypes noted. The risk of post-transfusion hepatitis (PTH) appears to be decreasing and this is attributed to both deferral of high-risk donors and more aggressive screening of donated blood. ⋯ Earlier recurrence of cancer and an increased incidence of postoperative infection have been associated with perioperative blood transfusion although the evidence is not persuasive. Microaggregate blood filters are not recommended for routine blood transfusion but do have a role in the prophylaxis of non-haemolytic febrile reactions caused by platelet and granulocyte debris in the donor blood. Patients should be advised when there is likely to be a requirement for perioperative blood transfusion and informed consent for transfusion should be obtained.
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The effects of halothane, isoflurane, and enflurane on background neuronal activity and reactive capability in the central nervous system were studied in cats. The background neuronal activity was assessed by midbrain reticular cell firing, which was measured by the method of multi-unit activity, and the EEG in the cortex, amygdala, and hippocampus. The reactive capability was assessed by evoked responses in the visual neuronal pathway. ⋯ These results indicate that all the agents studied had suppressive actions on background neuronal activity in the order halothane < isoflurane = enflurane. The effects on reactive capability were divergent among agents, e.g., enflurane enhanced, halothane suppressed, and the actions of isoflurane were intermediate. We conclude that the anaesthetic effects on background activity and on reactive capability are divergent and that suppression of reactive capability is a factor in determining the ease of clinical application of the anaesthetics.
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Randomized Controlled Trial Clinical Trial
EMLA partially relieves the pain of EMG needling.
The aim of this study was to evaluate the efficacy of the topical analgesic cream EMLA in alleviating the pains caused by needling in electromyography (EMG). During the course of regular neurophysiology clinics, 34 Caucasian patients of both sexes, aged 21 to 69 yr (mean 38.5 +/- 11.4 SD), scheduled for electromyography, were studied. The EMLA was spread thickly on two EMG sites on each arm: E site, on the lateral dorsal aspect of the forearm and A site, on the thenar eminence. ⋯ The untreated E site (placebo) was less sensitive than the untreated A site (VAS = 3.10 +/- 1.75 vs 6.09 +/- 1.96, P = 0.0001). Muscle insertion on E site was less painful on the EMLA sites than placebo (VAS = 2.83 +/- 2.45 vs 5.73 +/- 2.30, P = 0.0001). The VAS scores for skin and muscle insertion on A site were identical whether EMLA or placebo had been applied.(ABSTRACT TRUNCATED AT 250 WORDS)
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Although the surgical advantages of laparoscopic cholecystectomy (LC) have been reported, the anaesthetic problems associated with this new technique have not been well described. For the first 101 patients undergoing laparoscopic cholecystectomy at our institution, we prospectively documented intraoperative critical observations and adverse outcomes in the PACU (Post-Anaesthetic Care Unit). In order to put the magnitude of these problems into perspective, we compared, in an identical manner, the anaesthetic management and outcomes of two more familiar surgical groups, cholecystectomy by laparotomy (C), and laparoscopy for gynaecological examination (LG). ⋯ We have documented considerable postoperative anaesthetic benefits for patients undergoing laparoscopic cholecystectomy compared with conventional cholecystectomy. However, there is still considerable perioperative morbidity compared with gynaecological laparoscopies. Now that specific problems have been identified, they may be amenable to specific anaesthetic interventions.
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It has been previously demonstrated that the output of calibrated vaporizers is influenced by the concentration of nitrous oxide in the carrier gas. This study was performed to determine whether helium in the carrier gas affects the output of modern calibrated vaporizers. A factorial design was used to determine the influence of carrier-gas helium concentration, carrier-gas flow rate and vaporizer dial setting on the output of four vaporizers: Ohio Calibrated Enflurane, Ohio Calibrated Isoflurane, Ohmeda Isotec 4, and Dräger Vapor 19.1 Isoflurane. ⋯ There was an effect of helium concentration on vaporizer output in all models. None of these changes was clinically important, since vaporizer output did not vary by more than +/- 10%, except at high flows and at high helium concentrations with the Ohmeda Isotec 4. It is concluded that these vaporizers can be used safely with helium.