Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Clinical Trial Controlled Clinical Trial
Effects of single-dose oral ranitidine and sodium citrate on gastric pH during and after general anaesthesia.
The effects on gastric pH of the H2-receptor antagonist ranitidine (R) with 0.3 molar (M) sodium citrate (SC) as an oral effervescent and those of plain SC were studied in 25 patients scheduled for elective surgery. Following induction of general anaesthesia, the gastric contents were evacuated via a nasogastric tube, and a pH electrode was placed in the stomach. Then, eight patients received R 300 mg plus SC dose (Group R300), ten received R 150 mg plus SC dose (Group R150), and seven received 50 ml SC alone (Group SC). ⋯ These values increased to 7.0 (6.2-7.5), 6.9 (6.3-7.3), and 4.9 (1.9-7.3), respectively, at emergence from anaesthesia (P < 0.05 for R300 vs SC and R150 vs SC). Two minutes after administration of R300 and R150, a mean (range) gastric pH of 6.8 (5.8-7.5), and 5.6 (1.2-7.0), respectively, was reached, and remained above 2.5 for 14 hr (P = NS). Plain SC increased the gastric pH within two minutes to a mean of 6.8 (6.7-7.0), and maintained it above 2.5 for six hours (P < 0.05 for R300 vs SC at 8, 10, 12, and 14 hr after induction).(ABSTRACT TRUNCATED AT 250 WORDS)
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This study compared the costs of an inpatient elective surgical admission process with an outpatient based same day admission programme in patients undergoing laparoscopic cholecystectomy. The effect of this process change on annual surgical volume and case flow (number of procedures performed per surgical bed) in the year before the initiation of same-day method (1989/90) and subsequent to the widespread use of the process (1992/93), was also assessed. Costs incurred by 53 patients who underwent preoperative anaesthetic and surgical assessment as outpatients and were admitted as an outpatient on the day of surgery (SD Group) were compared with those incurred by 11 patients who entered hospital on the day before surgery and underwent anaesthetic and other assessments as inpatients (IP Group). ⋯ Total case flow improved by 12.2%, that for elective and non-elective surgery increasing by 14.1% and 9.5%, respectively. Elective surgery, where same day admission was used, showed the greatest improvement in case flow. We conclude that a same day admission process reduces cost and serves to enhance hospital productivity.
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Case Reports
Anaesthesia for caesarean section in a patient with myotonic dystrophy receiving warfarin therapy.
A 31-yr-old parturient with myotonic dystrophy and asthma presented for elective Caesarean section. The patient was receiving warfarin having had two previous episodes of thromboembolism. Anticoagulation was subsequently provided by heparin in the weeks prior to delivery. ⋯ Postoperative pain was relieved by using a continuous epidural infusion, transcutaneous nerve stimulation and diclofenac. No new neurological problems arose despite the use of epidural analgesia in the presence of heparin anticoagulation. This method of providing anaesthesia and postoperative analgesia without the use of opioids in an anticoagulated, asthmatic, myotonic parturient has not been described elsewhere.
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A previous study indicated that there were many citation errors in the Canadian Journal of Anaesthesia. After this report, editors of the Journal requested any contributors, whose papers were accepted for publication, to verify the accuracy of reference citation by including a photocopy of the first page of each reference. The present study examined if the accuracy of the reference list had improved. ⋯ Citation errors in Canadian Journal of Anaesthesia were considerably improved after the request to verify citation accuracy. Although this check-system probably contributes to the improvement of accuracy of reference citation, the rate of citation errors remains high. We believe that contributors' efforts will enhance the value of the journal.