Canadian journal of anaesthesia = Journal canadien d'anesthésie
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To report the use of vasopressin to treat a patient who, after failing to respond to volume expansion and epinephrine administration, experienced an anaphylactic reaction to rocuronium. ⋯ Vasopressin may be effective in the resuscitation of anesthetized patients, with hemodynamic instability associated with anaphylaxis resistant to epinephrine and alpha-agonists.
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Guillain-Barré syndrome (GBS) is an acute immunologic attack of the peripheral nerves causing rapidly ascending weakness and areflexia. Occasionally, weakness is severe enough to leave patients paralyzed and without adequate respiratory function. In such patients, intensive care unit (ICU) admission is required. Infrequently, GBS occurs in patients already admitted to the ICU. When this occurs, it can be difficult to distinguish GBS from critical illness neuropathy (CIN). However, it is important to consider GBS in these cases, since treatment options are available, and early treatment is associated with significantly improved outcome. ⋯ Guillain-Barré syndrome in trauma patients is rare and is limited to case reports following head trauma. This case also highlights the similarities and the subtle differences between GBS and CIN. Ultimately, definitive diagnosis of GBS may not be possible; however, an empiric course of intravenous immunoglobulins or plasma-exchange may be warranted, if GBS is a reasonable possibility.
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The focus of this paper is on consent issues surrounding pre-mortem transplantation optimizing interventions. First, we explore the potential consequences of the different types of pre-mortem transplantation optimizing interventions that might be used, and we examine the current Canadian practice with respect to these interventions. We then analyze the status of consent to pre-mortem transplantation optimizing interventions under the current legal framework. Finally, we provide recommendations on how to improve the current legal framework. ⋯ We argue that consent is legally required and must be express and competent patients have the legal authority to consent; but the law with respect to legal authority to consent on behalf of incompetent patients varies across the country. We come to the unsettling conclusion that the legality of pre-mortem transplantation optimizing interventions in many circumstances is at best questionable. We provide concrete recommendations (draft statutory text) on how to improve the current legal framework.
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Drugs that suppress neuronal activity, including all general anesthetics that have been tested thus far (ketamine, midazolam, isoflurane, propofol, and a cocktail of midazolam, nitrous oxide and isoflurane), trigger neuroapoptosis in the developing rodent brain. Combinations of nitrous oxide and isoflurane, or ketamine and propofol, cause more severe neuroapoptosis than any single agent by itself, which suggests a positive correlation between increased levels of anesthesia and increased severity of neuroapoptosis. In contrast, there is evidence that the rare gas, xenon, which has anesthetic properties, protects against isoflurane-induced neuroapoptosis in the infant rat brain, while not inducing neuroapoptosis by itself. The present study was undertaken to evaluate the potential of xenon to induce neuroapoptosis or to protect against neuroapoptosis induced by isoflurane in the infant mouse brain. ⋯ We conclude that xenon, in the infant mouse brain, has paradoxical properties. It triggers neuroapoptosis, and when combined with isoflurane, it increases the depth of anesthesia, and retains its own apoptogenic activity. However, it suppresses, rather than augments, isoflurane's apoptogenic activity.