Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The epidural electrical stimulation test (EEST) is a highly specific and sensitive test for confirming placement of the epidural catheter in the epidural space. The purpose of this study was to investigate if the EEST could predict the spread and consumption of local anesthetic solutions during labour epidural analgesia. ⋯ The EEST shows a wide range of electrical current requirements and elicits a variety of muscle twitch patterns on the lower limbs. Although it confirms the epidural placement of the catheter, the EEST cannot be used to predict the spread or consumption of the local anesthetic solution during labour epidural analgesia.
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Platelet transfusion in cardiac surgery is often empiric as no established point-of-care tests are available for clear guidance of blood product administration, and there are many variables that can potentially increase the risk of bleeding during cardiopulmonary bypass. The objectives of this study were to determine the factors that influenced physicians' decisions to transfuse platelets perioperatively and to determine whether these factors coincide with characteristics using chart abstraction. ⋯ The use of focused physician questionnaires identified relevant aspects of patient care not apparent in the chart review that influenced the decision to transfuse platelets. The identification of bleeding, thrombocytopenia, more complex surgery, and the presence of liver disease highlights the requirement for standardized measures to assess the need for platelet transfusions in bleeding patients.
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To describe the complex perioperative considerations and anesthetic management of a cognitively delayed blind adult male who underwent awake craniotomy to remove a left anterior temporal lobe epileptic focus. ⋯ This case shows that careful patient assessment, effective interdisciplinary communication, and a carefully tailored anesthetic strategy can facilitate an awake craniotomy in a potentially uncooperative adult patient with diminished mental capacity and sensory deficits.