Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Airway management in a patient with a cleft palate after pharyngoplasty: a case report.
To describe a practical method of aiding nasotracheal intubation in a cleft palate patient with previous pharyngoplasty using a suction catheter under tactile guidance. Problems of airway management in these patients are also discussed. ⋯ Preoperative determination of the type of pharyngoplasty is essential to understand the anatomy of the patent velopharyngeal port. A history of pharyngeal flap infection, hyponasal voice or upper airway obstruction suggests possible port stenosis. We describe a tactile guided technique that is useful and practical. Use of a flexible suction catheter of small external diameter minimizes the potential for trauma, bleeding and creation of false passages.
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The PiCCO System is a relatively new device allowing intermittent cardiac output monitoring by aortic transpulmonary thermodilution technique (Aorta intermittent) and continuous cardiac output monitoring by pulse contour analysis (Aorta continuous). The objective of this study was to assess the level of agreement of Aorta intermittent and Aorta continuous with intermittent (PA intermittent) and continuous cardiac output (PA continuous) measured through a special pulmonary artery catheter (Vigilance System SvO(2)/CCO Monitor) in patients undergoing single- or double-lung transplantation. ⋯ Measurements with the aortic transpulmonary thermodilution technique give continuous and intermittent values that agree with the pulmonary thermodilution method which is still the current clinical standard.
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Cumulative sum (cusum) analysis is a statistical and graphical tool that examines trends for sequential events over time. It has been used to determine proficiency in technical procedures. We used cusum to determine the number of labour epidural attempts necessary for proficiency in our training program. ⋯ After a period of training, residents are expected to perform the skill of labour epidural insertion independently. This study illustrates that some residents may need as many as 75 attempts to ensure proficiency. Training programs could use cusum to track the progress of their residents' technical skills in order to guarantee an adequate experience.
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Randomized Controlled Trial Clinical Trial
Nitrous oxide produces minimal hemodynamic changes in patients receiving a propofol-based anesthetic: an esophageal Doppler ultrasound study.
Nitrous oxide (N(2)O) is a frequently used adjunct to propofol anesthesia. Although N(2)O reduces the requirement of propofol for induction and maintenance, the effects of both drugs on overall hemodynamics remain controversial. We tested the hypothesis that the addition of N(2)O to therapeutic doses of propofol alters hemodynamics and Doppler-derived variables evaluated with the esophageal Doppler monitor in a randomized, double-blinded, placebo-controlled design. ⋯ Propofol causes dose-dependent decreases in ABF and MAP; however, 70% N(2)O produces minimal hemodynamic and Doppler-derived variable changes under target-controlled propofol infusion at therapeutic concentrations.