Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Clinical Trial
Humidification reduces coughing and breath-holding during inhalation induction with isoflurane in children.
Inhalation induction using isoflurane is associated with airway irritability, coughing, breath-holding and laryngospasm. These complications are more common in children. This study was designed to determine if humidification of isoflurane in oxygen/nitrous oxide would reduce respiratory complications and hypoxic episodes at induction. ⋯ Humidification of inspired isoflurane reduces the frequency and severity of coughing, the severity of breath-holding, and the need to increase supplemental inspired oxygen concentration, when isoflurane is used for inhalation induction of anaesthesia in children. Humidification has no effect, however, on the frequency and severity of laryngospasm, or on the frequency of occurrence of arterial oxygen desaturation.
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The literature describing the pulmonary mechanisms of increased PA-PaO2 during general anaesthesia was examined to define the role of airway closure and sub-radiological atelectasis. ⋯ Airway closure and atelectasis contribute equally to the increased ventilation: perfusion mismatching that occurs during general anaesthesia.
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Randomized Controlled Trial Clinical Trial
The reversal of profound mivacurium-induced neuromuscular blockade.
Mivacurium is metabolized by plasma cholinesterase catalyzed ester hydrolysis. Acetylcholinesterase antagonists used in the reversal of muscle relaxation may also inhibit plasma cholinesterase and, therefore, delay the hydrolysis of mivacurium. The clinical interaction between acetylcholinesterase antagonists and mivacurium induced neuromuscular blockade was studied. ⋯ Neostigmine reversal of intense mivacurium neuromuscular block should be avoided, as this may result in prolongation of the block.
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We report a case of a parturient with peroneal muscular atrophy-Charcot-Marie-Tooth disease type 1 (CMT)-who received epidural analgesia for labour. The effects of pregnancy and labour on the course of CMT are reviewed, together with the current literature on the provision of epidural and general anaesthesia in this disease. ⋯ Epidural analgesia, after thorough discussion with the patient, may be offered to parturients with CMT.