Canadian journal of anaesthesia = Journal canadien d'anesthésie
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We report a malignant hyperthermia-susceptible patient who required investigation for a large, symptomatic anterior mediastinal mass. Multiple attempts at tissue diagnosis under local anaesthesia were unsuccessful. ⋯ Diagnostic mediastinotomy was performed without incident. We conclude that ketamine anaesthesia is appropriate for patients with anterior mediastinal masses, and is considered safe in malignant hyperthermia-susceptible patients.
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Blood or plasma glucose concentration can be measured accurately and rapidly. However, after a glucose challenge metabolism may modify glucose kinetics, so that glucose has not been used as an indicator for dilution volumetry. To test the hypothesis that the initial distribution volume of glucose (IDVG) reflects cardiac output rather than glucose metabolism in the critically ill, the relationship between IDVG and thermodilution cardiac output was evaluated at 27 points in 13 non-surgical, critically ill patients without congestive heart failure. ⋯ Correlations were obtained between the IDVG and cardiac output (r = 0.89, n = 27, P < 0.001), and between the incremental plasma glucose concentrations three minutes after the injection and the IDVG (r = 0.94, n = 27, P < 0.001). No difference was found between the IDVG with or without continuous insulin infusions. The results indicate that the IDVG reflects cardiac output rather than glucose metabolism in patients without congestive heart failure.
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Case Reports
Successful epidural anaesthesia for a patient with Takayasu's arteritis presenting for caesarean section.
The management of a 24-yr-old parturient with Takayasu's arteritis (TA) presenting at term for Caesarean section is discussed. The best anaesthetic management for the patient with TA is controversial, but avoiding regional anaesthesia has been suggested by some authors because of the risk of hypotension and the subsequent need for vasopressors. We report the use of regional anaesthesia in a term parturient with severe TA undergoing Caesarean section. ⋯ The initial doses of 60 mg and 150 mg were followed by a decrease in BP (from 110/70 to 70/40) which was corrected with iv fluids and ephedrine 25 mg. Additional doses of chloroprocaine, 150 and 90 mg, were uneventful. It is concluded that an epidural can be made in safety to provide anaesthesia for Caesarean section in patients with TA.