Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Although spinal and epidural blocks provide excellent anaesthesia for many operations, they are frequently accompanied by hypotension. This is largely the result of sympathetic nerve blockade. Excessive hypotension may potentially produce myocardial and cerebral ischaemia, and is associated with neonatal acidaemia in obstetric practice. ⋯ In non-obstetric practice, ephedrine has a good track record but again its success rate is less than 100%. As there is no fetus to consider, it may be more appropriate to consider using a pure vasoconstrictor agent such as methoxamine or phenylephrine as a first-line therapy in such cases. This judgment can only be made on an individual patient basis as ephedrine produces a tachycardia while phenylephrine and methoxamine both produce bradycardia.
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The purpose of this study was to describe methods, risk factors, and outcomes of airway management in all patients (obstetrics excluded) attended by anaesthetists over 27 months. Preoperatively, anaesthetists recorded patient factors and assessed four airway characteristics. Methods of tracheal intubation and ease of direct laryngoscopy following general anaesthesia (easy, awkward, difficult) were noted. ⋯ Patients with difficult tracheal intubation had an increased rate of desaturation (< 90%), hypertension (> 200 mm Hg) and dental damage on induction of anaesthesia. It is concluded that difficult tracheal intubations occurred infrequently but were associated with increased morbidity. Patient factors and four physical airway characteristics were useful predictors but limited in identifying all problems.