Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The purpose of this article is to report the case of a patient who developed prolonged neuromuscular block after a large dose of clindamycin (2400 mg). A 58-yr-old, 65 kg woman with severe rheumatoid arthritis was admitted for wrist arthrodesis. After d-tubocurarine (3 mg) and fentanyl (1.5 micrograms.kg-1), anaesthesia was induced with thiopentone (4 mg.kg-1) followed by succinylcholine (1.5 mg.kg-1) and was maintained with N2O in O2 and isoflurane (0.75-1.0% end tidal) and ventilation was controlled. ⋯ Controlled ventilation was continued in the Recovery Room where neuromuscular testing showed a train-of-four ratio of 0.27 which improved to only 0.47 five minutes after calcium chloride (1.5 mg.kg-1 i.v.), and to 0.62 after edrophonium (20 mg) and neostigmine (2 mg). Nine hours later the patient began to cough, the TOF had returned to 1.0 and two hours later the trachea was extubated and spontaneous ventilation was resumed. Large doses of clindamycin can induce profound, long-lasting neuromuscular blockade in the absence of non-depolarizing relaxants and after full recovery from succinylcholine has been demonstrated.
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The study evaluated the warming ability and flow rates associated with four fluid warming devices during pressure driven infusion and during wide open gravity driven roller clamp infusion. Warmers tested were the Astotherm, Flotem IIe, Level 1 System 250 and a modified cardioplegia heat exchanger. Fluids tested were crystalloid, red cells diluted with 200 ml, 0.9% saline, and undiluted red cells. ⋯ Only the System 250 warmed red cells > 35 degrees C at gravity driven flow rates. The Flotem and Astotherm were not effective in warming rapidly infused solutions. None of the warmers tested was able to deliver fluids at normothermia (> 36.5 degrees C).
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To study the detrimental effects of operating room noise, noise levels in operating rooms were first measured and the average noise level was calculated in Decibels, which was 77.32 dB(A). An audiocassette of 90 min duration was prepared recording the operating room noise. The same audiocassette was used later to expose the 20 anaesthesia residents to the operating room noise in the acoustically treated rooms of audiology department. ⋯ The mean pre-exposure scores for the Trail Making Test, Digit Symbol Test and Benton Visual Retention Test were 22.9 +/- 1.94, 83 +/- 2.62 and 9.55 +/- 0.51 respectively. The mean during-exposure scores were 16.35 +/- 1.39, 74.05 +/- 3.46 and 5.8 +/- 0.41 respectively (P < 0.05). In conclusion, we observed that operating room noise reduced the mental efficiency and short-term memory of anaesthesia residents.
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Case Reports
Caudal epidural blood patch for the treatment of a paediatric subarachnoid-cutaneous fistula.
This clinical report describes the performance of an epidural blood patch in a four-year-old child with acute lymphocytic leukaemia, who developed a subarachnoid-cutaneous fistula from repeated lumbar punctures for chemotherapy. The epidural blood patch was performed using an #18-gauge epidural catheter threaded through a #16-gauge intravenous catheter via the caudal approach. This approach was successful in a child whose lumbar epidural anatomy was distorted due to a collection of subcutaneous cerebrospinal fluid making identification of the epidural space by the usual lumbar approach very difficult. This report demonstrates an alternative technique for the performance of an epidural blood patch.