Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The accuracy of bolus injections using different sized syringes was studied. A 1 ml bolus was delivered from a 1 ml, 5 ml, 10 ml, and a 20 ml syringe (n = 205). The 1 ml syringe was the most accurate (P less than 0.001) and the bolus delivered was the least variable (P less than 0.001). ⋯ The 5 ml syringe was the most accurate (P less than 0.05) and the 3 ml and 5 ml syringes delivered a bolus with the least variability (P less than 0.001). A 5 ml bolus was delivered from a 5 ml, 10 ml, and a 20 ml syringe (n = 123); in this case there was no significant difference in the accuracy or variability of bolus among the three syringes. We conclude that for accuracy of small volume boluses (less than 5 ml), small-sized syringes should be used.
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Three patients were studied to determine the changes in regional skin temperature and blood flow during extensive sympathetic blockade following total spinal anaesthesia (TSA). Skin temperature was measured at the right upper arm, the right anterior chest at the nipple level, the right hand and the foot, using infrared thermography. ⋯ The mean blood flow in three patients decreased to 26.1, 61.4, 51.7% of the control values 15 min after TSA. Our results indicate that extensive sympathetic nervous blockade during total spinal anaesthesia induces regional different changes in skin temperature and decrease in truncal skin blood flow.
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A literature review was undertaken to document the status of anaesthetic education in both the peer-reviewed anaesthesia and medical education literature. A search was performed using Silver Platter for the period 1983-91, and the most widely circulated medical education and anaesthesia journals in North America were reviewed in detail. Although anaesthetists are involved in many educational activities, the literature is oriented towards postgraduate training. ⋯ A limited number of teaching methods, especially simulators, have been the focus of much interest, while other methods, such as bedside teaching, have received little attention. Programs of recertification or maintenance of competence, which have been announced by certifying bodies, may place new emphasis on the study of the design, effectiveness, and outcome of continuing medical education. In conclusion, the review revealed that there are many opportunities for anaesthetists to conduct educational research into many traditional and new areas of medical education.
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Randomized Controlled Trial Clinical Trial
Maternal inspired oxygen concentration and fetal oxygenation during caesarean section.
This study was designed to determine whether fetal arterial and venous PO2 could be increased by increasing maternal FIO2 in the period between hysterotomy and birth. Two groups of ten patients were studied. All were anaesthetised with the same technique except for the FIO2 after hysterotomy. ⋯ Although the maternal arterial PO2 was higher at birth in the 100% O2 group (177.4 +/- 42.3 mmHg vs 281.0 +/- 94.2 mmHg), there were no differences between the arterial umbilical cord PO2 (19.3 +/- 5.7 mmHg vs 18.5 +/- 7.3 mmHg) and the venous umbilical cord PO2 (31.1 +/- 7.6 mmHg vs 33.0 +/- 10.8 mmHg). Awareness was present in one patient in the 50% O2 group and in four patients in the 100% O2 group but this difference was not statistically significant. It is concluded that a higher inspired maternal oxygen concentration between hysterotomy and birth does not result in any increase in fetal PO2.
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The potency of ORG 9426, a new nondepolarising muscle relaxant, has been estimated using two different modes of nerve stimulation in patients anaesthetised with thiopentone, nitrous oxide-oxygen and intravenous fentanyl. The force of contraction of adductor pollicis was measured following a single twitch (ST) at 0.1 Hz or a train-of-four (TOF) mode of stimulation at 2 Hz every ten seconds. Dose-response curves were constructed using a single-dose method. ⋯ The ED50S were not significantly different but the differences between ED90S and ED95S were significant (P less than 0.05) indicating greater sensitivity of the neuromuscular junction using TOF stimulation. The results of this study suggest that the information obtained by single-twitch stimulation is not the same as that obtained from the first response of the TOF stimulation, suggesting apparently increased sensitivity (and apparently greater potency) with the TOF mode of stimulation. Org 9426 appears to be a drug with relatively low potency.