Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The treatment of cerebral arteriovenous malformations (AVM) or vascular anomalies are challenging neurosurgical procedures for an anaesthetist. Large AVMs are uncommon in children. Only 18% of AVMs become symptomatic before the age of 15 yr. ⋯ Children presenting with intracranial arteriovenous malformations require a multidisciplinary approach. The successful management of anaesthesia either for embolization or surgical resection necessitates an understanding of the disciplines of paediatric and neuroanaesthesia. Special care and specific attention to detail may contribute to reduce the high morbidity and mortality encountered in these compromised children.
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A case report of a 27-yr-old healthy patient for Caesarean section under epidural anaesthesia is presented. The patient suffered an acute cardiorespiratory collapse when the infant's head was being delivered through the anterior abdominal wall. The patient remained cyanosed after proper tracheal intubation and pulmonary ventilation with 100% O2. ⋯ A pulmonary artery catheter inserted three hours after the event showed normal pressures and a high cardiac output. The patient suffered permanent neurological damage. The differential diagnosis is discussed and current concepts of the aetiology and management of amniotic fluid embolism reviewed.
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The objective of this review is to review the anaesthetic implications of vasoactive compounds particularly with regard to the cerebral circulation and their clinical importance for the practicing anaesthetist. Material was selected on the basis of validity and application to clinical practice and animal studies were selected only if human studies were lacking. Hypotensive drugs have been used to induce hypotension and in the treatment of intraoperative hypertension during cerebral aneurysm surgery. ⋯ Hypertension should be treated immediately to reduce the risk of rebleeding and intraoperative aneurysmal rupture and the choice of drugs is discussed. Although the use of induced hypotension has declined, the control of arterial blood pressure with vasoactive drugs to reduce the risk of intraoperative cerebral aneurysm rupture is a useful technique. Intraoperative hypertension should be treated immediately but the cerebral vascular effects of each vasodilator should be understood before their use as hypotensive agents.
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The role of anaesthetists in providing local anaesthesia for intraocular surgery has changed over the past decade. No longer confined to the interested few, more and more anaesthetists are involved in monitored care and/or are performing eye block anaesthesia. This review summarizes the information related to eye block anaesthesia. ⋯ Complications such as retrobulbar haemorrhage, globe penetration/perforation, visual impairment, brainstem anaesthesia, muscle injury, and oculocardiac reflex are explored. The implications of anticoagulant therapy are examined. The choice between retrobulbar and peribulbar blocks and the role of anaesthetists are discussed.
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Nurse-administered analgesia is simple, universally accessible, and cost-effective. This route of administration must be fully explored and exploited to gain maximal analgesia at minimal cost. Combined, balanced multimodal analgesia with NSAIDs and opioids used preoperatively to prevent pain should be encouraged. ⋯ This requires a multi-disciplinary team of health care professionals and a multi-modal array of analgesics. This approach represents a change from current practice. Considerable time and energy has been invested in the development of the clinical practice guidelines and they deserve our consideration as we manage patients now and in the future.