Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Successful tracheal intubation with Augustine Guide (Augustine Medical, Inc., Eden Prairie, MN) in patients with normal airways has recently been described. There are no studies describing Augustine Guide (AG) use in patients with difficult airways. Accordingly, we studied AG intubation in a population of patients with expected difficult airways due to cervical spine pathology, limited mouth opening, obesity, facial trauma or deformity due to previous operation or radiation and in patients with unexpectedly difficult airways. ⋯ Using the AG, all were intubated successfully (36/44 at the first attempt, in 8/44 repositioning of the AG to allow successful laryngeal entry of the stylet was necessary). There were no failures or complications secondary to AG use. This study shows that the AG is a useful device for oral tracheal intubation in patients with known or unexpectedly difficult airways.
-
The authors report the successful treatment of post-dural puncture headache, consequent to a cervical dural puncture, with a lumbar extradural blood patch. The increase in intracranial pressure generated by the injection of autologous blood in the extradural space seems to be the likely mechanism for the prompt relief of post-dural puncture headache. We conclude that extradural injection of autologous blood at the same level of the dural puncture may not be necessary.
-
Spinal anaesthesia has been used since the 1800s but, due to a number of complications, the popularity of this technique has waxed and waned. In the 1950s, it was the most widely used method of anaesthesia and analgesia in obstetrics but it fell out of fashion with the arrival of the epidural technique which allowed a continuous method of delivering analgesia with relatively few complications. ⋯ With the development of newer needles and bevel designs and methods whereby the incidence of hypotension can be minimized, spinal anaesthesia is making a reappearance in obstetrical anaesthesia spheres. The purpose of this article is to review the history, effects, technique, indications, contraindications and complications of this method of anesthesia as it applies to the obstetrical patient.
-
Randomized Controlled Trial Clinical Trial
Alkalinization of lidocaine 2% does not influence the quality of epidural anaesthesia for elective caesarean section.
This double-blind randomized study compared the effects of an epidural injection of lidocaine hydrochloride 2% (HCl) (Group 1), alkalinized lidocaine 2% (1 ml NaHCO3 per 10 ml of solution) injected either immediately (Group 2) or one hour after preparation (Group 3) in 45 parturients (n = 15 per group) scheduled for elective Caesarean section. Each patient received 16 ml of one of the three solutions. The mean pH values measured just before administration with a pH-meter PHM 64 Metrohm AG were 6.77 for the HCl lidocaine 2% solution, 7.34 for the freshly alkalinized solution and 7.35 for the solution prepared one hour before injection. ⋯ A motor block of grade 2 or 3 on the Bromage scale was obtained in 11, 10 and 14 patients respectively. No failure was observed although 3, 5, and 2 patients in Groups 1, 2, and 3 respectively required a supplementary bolus 20 min after the initial injection because of inadequate sensory level or pain at the operative site. In conclusion, this study shows that neither fresh alkalinization of 2% lidocaine nor the delay of one hour between preparation and injection of the alkalinized solution influences the onset or quality of epidural anaesthesia for elective Caesarean section.
-
We describe the use of a laryngeal mask airway in three adult patients whose mouth opening varied from 12 mm to 18 mm. The first patient's incisal opening was 12 mm. His airway was otherwise normal and the standard laryngeal mask was used as the definitive airway for the 90 min revision of facial scars and bone graft to mandible. ⋯ The third patient, in addition to a mouth opening of only 18 mm, had limited neck movement from previous flap reconstruction following mandibulectomy, hemiglossectomy and radical neck dissection. For three more reconstructive head and neck procedures that ranged from 90 min to nine hours, the flexible reinforced laryngeal mask was inserted under topical anaesthesia and its correct position confirmed by fibreoptic laryngoscopy before induction of general anaesthesia. Maintenance of anaesthesia in all cases was uneventful and there were no postoperative complications.