Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Administration of epidural and intrathecal opioids may provide excellent postoperative analgesia, but a minority of patients will suffer dangerous respiratory depression. This review discusses the detection and measurement of respiratory depression and summarizes the relevant literature as it pertains to epidural and intrathecal opioid administration. The respiratory depressant effects and pharmacokinetics of spinal opioids are reviewed. The clinical implications and areas of future investigation are discussed.
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Clinical examination of a patient is very likely to reveal the factors making tracheal intubation difficult and thus increasing the likelihood of a traumatized temporo-mandibular joint or mouth. Although laryngoscopes and bronchoscopes incorporating fiberoptic visual devices are invaluable they are usually only employed for extremely difficult patients. ⋯ An atraumatic tracheal intubation will be assisted if the laryngoscope blade to be used is selected on the basis of the anatomic difficulties prescribed by the patient. The Miller, Jackson-Wisconsin, Macintosh, Soper, Bizarri-Guffrida, and Bainton blades together with appropriate handles and fittings comprise a group from which selection can be made.
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Magnesium plays an important role as a cofactor in many of the body's critical functions and reactions. A deficiency or excess of extracellular magnesium can produce significant signs and symptoms. Hypomagnesaemia is a common finding in hospitalised patients, especially those in critical care areas. ⋯ Hypermagnesaemia is often iatrogenic and is more likely in patients with renal dysfunction who are receiving oral or parenteral magnesium. The specific antidote is intravenous calcium. Anaesthetised patients with high serum magnesium levels are at risk from hypotension, potentiation of non-depolarising neuromuscular blockers, postoperative respiratory failure and cardiac arrest.