Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Clinical Trial
Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury.
The objective of this study was to identify predictors of death and mechanical ventilation in patients with traumatic cervical spinal cord injury. ⋯ Age, neurological level and GCS are independent predictors of mortality in patients with traumatic cervical spinal cord injury. Copious sputum and pneumonia are independent predictors of the need for mechanical ventilation.
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Case Reports
Long-term epidural ketamine, morphine and bupivacaine attenuate reflex sympathetic dystrophy neuralgia.
There is considerable evidence that NMDA receptor antagonists can abolish nociceptor hypersensitivity in animals. In the present case report, two patients with reflex sympathetic dystrophy were treated with ketamine, a NMDA antagonist, morphine and bupivacaine. ⋯ Epidural coadministration of low doses of morphine, ketamine and bupivacaine provided effective pain relief in two patients. This suggests synergy from this combination that provides an alternative treatment for reflex sympathetic dystrophy.
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Respiratory acidosis during carbon dioxide (CO2) insufflation has been suggested as a cause of spontaneous abortion and preterm labour following laparoscopic cholecystectomy during pregnancy. Capnography may not be adequate as a guide to adjust pulmonary ventilation during laparoscopic surgery and hence arterial carbon dioxide (PaCO2) monitoring has been recommended. We report the feasibility and benefits of transcutaneous carbon dioxide monitoring (PtcCO2) as an approach to optimise ventilation during laparoscopic surgery in pregnancy. ⋯ Continuous PtcCO2 measurements as well as squeeze PETCO2 may be of clinical value in trending and preventing hypercarbia during laparoscopic surgery.
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To report the successful perioperative anaesthetic and analgesic management of a spinal trauma patient with a surgically placed epidural catheter. ⋯ A surgically placed epidural catheter provided excellent, safe, perioperative anaesthesia and analgesia in this patient with unstable spinal trauma.
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While advanced cardiac life support (ACLS) training is widely available, it is not mandatory for all anaesthetists. We hypothesised that adherence to ACLS guidelines during resuscitation of ventricular fibrillation (VFib) as assessed in a simulator environment would be poor by anaesthetists not trained in ACLS compared with those who had received training. ⋯ Adherence to ACLS guidelines was poor. A greater proportion of subjects without previous ACLS training had deviations from protocol than did subjects who had received training. We need to consider ways to ensure that anaesthetists obtain and retain resuscitation skills according to ACLS guidelines.