Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Administration of sc morphine has been recommended two hours after the end of iv morphine titration in the postanesthesia care unit (PACU), but in some cases patients complain of pain earlier than this. We assessed pain after the end of iv morphine titration and studied the characteristics of patients who needed rescue sc morphine. ⋯ Sedation during titration and an initial VAS > or = 60 are characteristics of the patients who require rescue (less than two hours) sc morphine after iv morphine titration.
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The 2003 ASA Practice Guidelines for Management of the Difficult Airway suggest the early use of the Laryngeal Mask Airway and Combitube as rescue airway devices in the cannot ventilate-cannot intubate situation, switching the focus from laryngoscopy and intubation to ventilation and oxygenation. The Practice Guidelines are not intended as standards but as recommendations. Multiple new alternative airway devices were described in the last ten years. The Laryngeal Tube (LT) is a new Food and Drug Administration approved supraglottic airway device. The device is in use in Europe since 1999 and in the United States since 2002. ⋯ In these clinical situations of unexpected difficult airway with significant periglottic obstruction the LT provided adequate ventilation after the first insertion. The LT may complement the laryngeal mask airway in difficult airway management. Further research is needed to define the role of the LT in the management of difficult airways.
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To report the first use of spinal anesthesia for Cesarean section (CS) in a parturient with a long QT syndrome (LQTS) and an automatic implantable cardiac defibrillator (AICD). Although both general and epidural anesthesia have been described for CS in patients with LQTS, there are no previous case reports on the use of spinal anesthesia. The clinical features, diagnosis, treatment and anesthetic management of LQTS are discussed. ⋯ Spinal anesthesia was used safely for CS in this parturient with LQTS.
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To determine if central sympathetic blockade by dexmedetomidine, a selective alpha(2) adrenergic receptor agonist, prevents cardiac dysfunction associated with intracranial hypertension (ICH) in a rat model. ⋯ The results demonstrate that dexmedetomidine attenuates cardiac dysfunction associated with ICH. Our results provide evidence for the role of central sympathetic hyperactivity in the development of cardiac dysfunction associated with ICH.