Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The laryngeal mask airway (LMA) has been used extensively to provide a safe airway in spontaneously breathing patients who are not at risk from aspiration of gastric contents. The role of the LMA in the event of a failed intubation in an obstetrical patient, and its place in a failed intubation drill remains unclear. Two hundred and fifty consultant obstetric anaesthetists in the United Kingdom were asked to complete an anonymous questionnaire regarding their views about using the laryngeal mask airway (LMA) in obstetrical anaesthesia. ⋯ Seventy-two per cent of anaesthetists were in favour of using the LMA to maintain oxygenation when tracheal intubation had failed and ventilation using a face mask was inadequate. Twenty-four respondents had had personal experience with the LMA in obstetrical anaesthesia, eight of whom stated that the LMA had proved to be a lifesaver. We believe that the LMA has a role in obstetrical anaesthesia when tracheal intubation has failed and ventilation using a face mask proves to be impossible, and it should be inserted before attempting cricothyroidectomy.
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We have compared the dose requirements and recovery characteristics of a continuous mivacurium infusion given by the anaesthetist to maintain 95-100% block at the hand muscles with that of a surgeon-controlled, on-demand dosing technique based on the direct assessment of abdominal muscle tone during elective Caesarean section. Twenty-four full term pregnant patients were included. A rapid-sequence induction using thiopentone 3-5 mg.kg-1 and succinylcholine 1 mg.kg-1 was used. ⋯ The total doses of mivacurium (mean +/- SD) were 23.2 +/- 10.4 and 12.4 +/- 3.5 mg in the infusion and SCR groups, P < 0.01. On-demand, surgeon-controlled doses of mivacurium were injected at a mean of T1 42.3 +/- 36%. At the end of surgery, T1 and TOF ratio were respectively 16.7 +/- 13%, 5 +/- 10% and 48 +/- 37%, 30 +/- 24% in the infusion and SCR groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Midazolam coinduction does not delay discharge after very brief propofol anaesthesia.
Previous reports have demonstrated synergism of midazolam and propofol for induction of anaesthesia in humans. We tested the hypothesis that in the presence of alfentanil, the combination of midazolam with propofol for a very brief operative procedure would not affect the recovery phase. During pre-oxygenation, 64 outpatients scheduled for dilatation and curettage received placebo, or low-dose midazolam (0.03 mg.kg-1), or high-dose midazolam (0.06 mg.kg-1) iv, in a randomized double-blind manner. ⋯ Midazolam delayed time to eye-opening (P = 0.02) but not time to discharge-readiness. This study had an 80% power to detect a 39 min difference in time to discharge-readiness. We conclude that midazolam propofol co-induction in the presence of alfentanil delays eye-opening, but does not delay discharge after anaesthesia.
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Autonomy is a central ethical principle of medical practice. The physician's autonomy is usually expressed in concert with the other, overriding, ethic of medical care: beneficence. The autonomy of patients, however, has had a growing influence on medical decision-making and can complicate the process. ⋯ Such communication, however, can be obstructed by social values about life and death and the urgent nature of medical care in these situations. To show how such communication ought to be incorporated into medical decision-making, one of the most difficult situations is examined hypothetically: the patient who has a DNR order but who consents to undergo anaesthesia and surgery. In these cases, frequent communication between physician and patient about each therapy and its effect most often will resolve dilemmas.
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Randomized Controlled Trial Clinical Trial
Preemptive opioid analgesia does not influence pain after abdominal hysterectomy.
Opioid administration before surgical stimulus may reduce or prevent subsequent pain. We studied the effect of timing of opioid administration on the pain-related behaviour after abdominal hysterectomy. Eighty-five patients scheduled for abdominal hysterectomy were blindly randomized to receive fentanyl 10 micrograms.kg-1 before induction of anaesthesia (FA), after peritoneal incision (FB) or after removal of the uterus (FC), or sufentanil 1 micrograms.kg-1 before induction of anaesthesia (SA) or after peritoneal incision (SB) respectively. ⋯ The times from skin closure to the first analgesic request did not differ among the five groups. The VAS scores using the two-way ANOVA with repeated measurements differed among the five groups (F = 4.046, df = 4, 213, P < 0.005). The VAS scores with one-way ANOVA differed among the five groups 30 min postoperatively (F = 4.542, df = 4, 58, P < 0.003), being higher in the FA (6.5 +/- 1.8) and SA (5.9 +/- 2.1) groups than in the FC (3.2 +/- 2.5) group, and at 120 min postoperatively (F = 3.217, df = 4, 18, P < 0.05), being higher in the FA than in the FB group (6.1 +/- 1.5 and 2.6 +/- 1.9 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)