Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Displacement of the larynx by backward, upward and rightward pressure on the thyroid cartilage or "BURP" may improve visualization of the glottis in some cases of difficult direct laryngoscopy. In a patient with the Treacher-Collins syndrome in whom conventional laryngoscopy had proved impossible and tracheal intubation extremely difficult, this manoeuvre exposed the entire glottis and made tracheal intubation under direct vision easy. In a patient with protruding upper incisors and a prominent premaxilla which precluded a view of the glottis by conventional laryngoscopy, "BURP" again revealed the glottic opening and simplified the placement of an endotracheal tube. This experience suggests that "BURP" be considered as a potential aid in the management of difficult direct laryngoscopy.
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Randomized Controlled Trial Clinical Trial
Patient-controlled epidural analgesia in labour: varying bolus dose and lockout interval.
This double-blind prospective study was designed to determine the best dose variables for patient-controlled epidural analgesia (PCEA) and to compare bolus-only PCEA with continuous infusion epidural analgesia (CIEA) during the first stage of labour. Five groups of parturients self-administered 0.125% bupivacaine with 1:400,000 epinephrine and fentanyl 2.5 micrograms.ml-1 using PCA pumps programmed as follows: Group A, 2 ml bolus/10 min lockout interval (LI); Group B, 3 ml bolus/15 min LI; Group C, 4 ml bolus/20 min LI; Group D, 6 ml bolus/30 min LI; Group E, 8 ml.hr-1 continuous infusion. Hourly assessments included: VAS scores for pain and satisfaction, sensory and motor block, bupivacaine and fentanyl consumption. ⋯ There was higher consumption of bupivacaine and fentanyl in Group E than in any of the other four groups: bupivacaine mg.hr-1, mean (SD), 9.4 (2.7) in Group E vs 5.2 (1.7) in Groups A-D inclusive (P < 0.0001); fentanyl microgram.hr-1, 19.6 (4.6) in group E vs 12.6 (7.5) in Groups A-D inclusive (P < 0.05). Motor block was minimal, whereas sensory levels were higher at the 3- and 4-hour assessments in Groups D and E than in all other groups (P < 0.05). Plasma fentanyl concentrations were < 0.5 ng.ml-1 in all samples and no sequelae from fentanyl were observed, apart from mild pruritus.(ABSTRACT TRUNCATED AT 250 WORDS)
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The aim of this study was to investigate the relationship between preoperative oral fluids and gastric pH and volume in women undergoing sterilization between one and five days postpartum. Fifty postpartum patients received 150 ml water approximately two to three hours before surgery while 50 postpartum and 50 non-pregnant women were fasted from midnight. After induction of anaesthesia, gastric contents were aspirated using a Salem sump tube and the gastric pH and volume were measured. ⋯ There was no correlation between postpartum interval, 60 (12-120) hr, and intragastric pH or volume. It is concluded that oral water may be given safely two to three hours preoperatively to patients more than one day postpartum. Intragastric volume and acidity were not increased and the findings in postpartum patients were similar to those found in non-pregnant patients.
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Case Reports
Delayed ischaemia of the hand necessitating amputation after radial artery cannulation.
We present a case of ischaemic hand injury in a patient, who had 95% occlusion of both the ulnar and radial arteries, after atraumatic placement of a left radial artery catheter. The presence of cigarette burns on the dorsum of the hand was highly suggestive of vascular compromise. ⋯ Ten days after placement the patient complained of pain with ensuing ischaemic changes resulting in necrosis of the finger tips and eventual amputation of the hand. We recommend using other sites of arterial access such as axillary or superficial temporal artery in patients with severe peripheral vascular disease.