Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Clinical Trial
Does a mid-lumbar block level provide adequate anaesthesia for transurethral prostatectomy?
In this prospective, randomized study, 23 patients having spinal anaesthesia for transurethral prostatectomy (TURP) were evaluated for the adequacy of their block using a visual analog pain score (VAPS). Each patient with a "standard" (> or = T10) block level (n = 5) or "intermediate" (L1 or T12) block level (n = 5) found the block adequate. Sixty-two percent (8/13) of patients with a "low" (< or = L3) block level found their block adequate. ⋯ However, a smaller (P < 0.05) maximum percent decrease in diastolic blood pressure was found in LBPs, than in "intermediate" or "standard" block patients. It is concluded that a spinal block > or = L1 is adequate during TURP when bladder pressure is monitored and kept low. Mid-lumbar block levels should be reserved for patients in whom the benefit of minimizing haemodynamic changes outweighs the risk of a "less complete" anaesthetic.
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Several brands of laryngoscopes and commonly used blades are evaluated for differences in direct light intensity and area of illumination. The purpose of this study was to determine which laryngoscope/blade combination provided the best lighting conditions for tracheal intubation. The direct light intensity was assessed by directing various laryngoscope/blade combinations towards a multifunction exposure meter (Flash Meter III, Minolta Corp.). ⋯ When fitted on regular size handles, blades with incandescent bulbs provided more intense light than blades using fibreoptic light sources (P = 0.0078). For blades using incandescent light, the use of a short handle laryngoscope resulted in a decrease in light intensity (P = 0.0117). The results of this study suggest that blades using incandescent light provide greater light intensity than blades using fibreoptics.
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Most patients undergoing general anaesthesia are apnoeic during laryngoscopy and tracheal intubation. This study determined the time until the onset of desaturation following pre-oxygenation in apnoeic infants, children, and adolescents. Fifty ASA physical status I patients, 2 days to 18 yr of age, were studied. ⋯ Children became desaturated faster than adolescents (160.4 +/- 30.7 vs 382.4 +/- 79.9 sec, P < 0.0001). The time required to reach 90% saturation correlated well with age by linear regression analysis (r2 = 0.88, P < 0.0001). We conclude that the time to onset of desaturation following pre-oxygenation with mask ventilation increases with age in healthy apnoeic children.(ABSTRACT TRUNCATED AT 250 WORDS)
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Neuroleptic malignant syndrome (NMS) and malignant hyperthermia (MH) may have a common pathogenic mechanism; therefore, it has been suggested that known triggering agents for MH (such as succinylcholine) should be avoided in patients with NMS. Electroconvulsive therapy (ECT) continues to play a major therapeutic role in contemporary psychiatry, and succinylcholine has been the muscle relaxant of choice in attenuating violent muscle contractions induced by ECT. Mivacurium is a non-depolarizing muscle relaxant with a relatively rapid onset and a short duration of action, and to date it has been proved safe in MH-susceptible patients. ⋯ Since the patient's mental status necessitated further ECT, mivacurium was administered during subsequent treatment and resulted in effective attenuation of muscle contractions without elevation of patient temperature or CK levels. In addition, there was no marked prolongation of the anaesthetic. Mivacurium is a suitable agent for patients with NMS undergoing ECT, as it has not been associated with precipitation of an MH response.
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Randomized Controlled Trial Comparative Study Clinical Trial
Optimal anti-emetic dose of granisetron for preventing postoperative nausea and vomiting.
In order to determine the optimal effective dose of granisetron for preventing postoperative nausea and vomiting, the drug was administered in doses of either 20, 40 or 60 micrograms.kg-1. The efficacy of granisetron was evaluated in a randomized, double-blind comparison with placebo in 100 patients undergoing general anaesthesia for major gynaecological surgery. The patients received a single dose of either granisetron or placebo (saline) iv immediately after recovery from anaesthesia. ⋯ The mean scores were 0.7, 0.6, 0.2 and 0.2 after administration of placebo, granisetron 20, 40 and 60 micrograms.kg-1, respectively. Granisetron 40 micrograms.kg-1 was as effective as 60 micrograms.kg-1 and both resulted in reduction of the scores compared with placebo and granisetron 20 micrograms.kg-1 (P < 0.05). In conclusion, granisetron 40 micrograms.kg-1 is considered to be the appropriate dosage for preventing postoperative emesis after anaesthesia.