Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The N-CAT is a newly developed arterial tonometer (TBP) able to determine systolic, diastolic and mean arterial blood pressures continuously and noninvasively. The aim of this study was to evaluate the accuracy and reliability of TBP relative to directly measured invasive blood pressure (IBP) in ten haemodynamically stable postoperative cardiac patients who were in rapid atrial fibrillation (HR > or = 100 bpm). ⋯ Although these biases are within the required standards for equivalency for noninvasive blood pressure to invasively determined blood pressure, approximately 20% of the readings were > +/- 10 mmHg while only 5% were > +/- 20 mmHg. Moreover, there were occasional discrepancies of sufficient magnitude and duration which may limit the clinical usefulness of the N-CAT in patients in whom continuous and accurate blood pressure measurement is required.
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Randomized Controlled Trial Clinical Trial
Epidural anaesthesia and analgesia do not affect energy expenditure after major abdominal surgery.
Our objective was to determine the effect of perioperative epidural anaesthesia and analgesia on the increase in energy expenditure which accompanies major elective abdominal surgery in a prospective, randomized study. Eight patients undergoing elective resections of the colon and/or rectum received general anaesthesia alone (nitrous oxide, oxygen, and isoflurane, supplemented with intravenous fentanyl to a maximum of 10 micrograms.kg-1), and 12 patients received perioperative epidural anaesthesia and analgesia using lidocaine (carbonated lidocaine 2% with epinephrine 1:200,000, 20 ml over 30 min) and morphine (preservative-free morphine 0.10 mg.kg-1 after catheter insertion and 0.05 to 0.10 mg.kg-1 every 12 hr as needed until the morning following surgery) via a lower lumbar catheter in addition to general anaesthesia. ⋯ Oxygen consumption, carbon dioxide production, and energy expenditure increased after surgery (all P < 0.001) but were very similar in the two groups (all P > or = 0.8) before and after surgery. Despite substantial effects on postoperative pain, we conclude that oxygen consumption and energy expenditure following major abdominal surgery are not diminished by perioperative epidural anaesthesia and analgesia.
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We report a case of spinal subdural haematoma with neurological deficit in a 36-yr-old woman following Caesarean section for severe preeclampsia and placental abruption. She had been taking chronic trifluoperazine treatment for depression. Her activated partial thromboplastin time (aPTT) was 49 sec (normal = 26-36) but all other tests of coagulation were normal. ⋯ Seventy-two hours after delivery, she was found to have bilateral leg weakness, urinary incontinence, absent rectal sphincter tone and asymmetrical leg reflexes. The diagnosis of spinal haematoma was confirmed by magnetic resonance imaging. She underwent emergency laminectomy and made a full neurological recovery.
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Oesophageal, rectal, bladder, tympanic and pulmonary artery sites are used intraoperatively to measure body temperature. However, the temperatures measured at each site have different physiological and practical importance. The present two-part study sought to compare liquid crystal (CR) skin temperature with other temperature monitors which are used routinely during surgery. ⋯ During the first part, the mean difference between OS and CR was -0.14 +/- 0.85 degrees C; this difference remained consistent over time (P < 0.05 by repeated measures analysis of variance). During the second part, the difference in temperature readings between CR and each of the other monitors remained consistent except for CR vs PA and CR vs OS during the cooling period of CPB, when the iced cardioplegia slush directly affected the PA and OS temperatures. This study suggests that CR, an inexpensive and noninvasive means of temperature monitoring, reflects trends in temperature changes in the clinical setting.