Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Laparoscopic cholecystectomy (LC) offers advantages over open cholecystectomy (OC) of more rapid patient recovery. The comparative amount of pain that patients must endure after each of these procedures is not clear. We retrospectively analysed the use of patient-controlled analgesia (PCA) of an unselected sample of patients having either LC or OC procedures to quantitate morphine use, as well as pain and sedation scores in the postoperative period. ⋯ The rates of morphine use averaged over the day of surgery were 1.28 +/- 0.8 mg.hr-1 and 2.33 +/- 0.8 mg.hr-1 for LC and OC patients (P < 0.05). Despite higher PCA morphine use in OC patients, their pain scores were higher while their sedation scores were comparable. These data suggest that laparoscopic cholecystectomy is associated with less pain than open cholecystectomy in the day after surgery.
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The present study was designed to determine the time-course of recovery of the train-of-four (TOF) ratio during spontaneous recovery from mivacurium-induced block. Fifteen patients, free of neuromuscular disease, undergoing general endotracheal anaesthesia with isoflurane were studied. After anaesthetic induction, patients received a bolus dose of mivacurium 0.15 mg.kg-1. ⋯ The DUR0.3-0.9 averaged 11.8 +/- 3.9 min (range 6.0-20.2 min). There was no evidence of prolongation of recovery times (cumulation) following repeated dosing. The present data indicate that, in patients with normal cholinesterase activity (clinical duration 7-25 min), waiting 20 min beyond the time when fade is no longer apparent by visual or tactile evaluation is sufficient to attain a TOF ratio greater than 0.7-0.9 during spontaneous recovery from mivacurium, and may enable anaesthetists to avoid antagonism of mivacurium-induced block.
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Ebstein's anomaly is an uncommon congenital cardiac defect which is associated with cyanosis and arrhythmias. There have been very few previous reported cases of successful outcome in pregnancy in women with this disorder. We describe the successful analgesic management of an obstetric patient who had been known to have Ebstein's anomaly since childhood. ⋯ Vaginal delivery was managed with elective lift-out forceps to minimize the stress of pushing. When reviewed two months post-partum she still required digoxin although her symptoms had improved considerably. The successful management of Ebstein's anomaly in pregnancy should include team management from early in pregnancy.
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The shift to direct entry into residency training from medical school for all graduates will offer new challenges for anaesthesia training programmes. In this paper we argue that it also offers us an opportunity to re-evaluate our current approach to anaesthesia education. Emphasis in the residency programmes should be to provide trainees with clinical experiences and stimulation that will develop the required traditional competencies. ⋯ Faculty development will be required to help the resident pursue these skills of self-evaluation and efficient learning. We believe that incorporation of an experiential curriculum into the residency training programme will achieve the goals listed above and allow maturation of the process of lifelong learning. It will also allow greater achievement of the application of new information to one's practice.
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Comparative Study
A comparison of sevoflurane with halothane, enflurane, and isoflurane on bronchoconstriction caused by histamine.
This study was conducted to assess the effect of sevoflurane on lung resistance and compliance, and its responsiveness to histamine. We studied eight dogs to compare the effect of sevoflurane, isoflurane, enflurane, and halothane on bronchoconstriction caused by histamine. Baseline values of pulmonary resistance (RL) and dynamic pulmonary compliance (Cdyn) were measured prior to administration of histamine. ⋯ In preventing decreases in Cdyn, sevoflurane was less effective than halothane only at 8 micrograms.kg-1 of histamine under 1 and 2 MAC anaesthesia. There was no difference in attenuating effect on changes in RL and Cdyn between sevoflurane and isoflurane or enflurane. We concluded that sevoflurane was less potent than halothane in attenuating changes in RL and Cdyn in response to iv histamine.