Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Surgical repair of hip fracture and total hip arthroplasty are primarily performed on elderly patients. Patients presenting for hip fracture surgery have a high prevalence of preoperative medical problems and may require medical stabilization before surgery. Regional anaesthesia for hip fracture repair may be contraindicated due to perioperative pharmacologic prophylaxis for deep venous thrombosis. ⋯ Intraoperative instability with hypoxaemia, hypotension and cardiac arrest may follow impaction of the femoral prosthesis and are related to absorption of acrylic cement monomers and pulmonary embolism of fat, air, and platelet-fibrin aggregates. Postoperative deep venous thrombosis is common and the incidence may be reduced with epidural anaesthesia. Operative mortality is less than one per cent and pulmonary embolism is the commonest cause of death.(ABSTRACT TRUNCATED AT 250 WORDS)
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Administration of epidural and intrathecal opioids may provide excellent postoperative analgesia, but a minority of patients will suffer dangerous respiratory depression. This review discusses the detection and measurement of respiratory depression and summarizes the relevant literature as it pertains to epidural and intrathecal opioid administration. The respiratory depressant effects and pharmacokinetics of spinal opioids are reviewed. The clinical implications and areas of future investigation are discussed.
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Clinical examination of a patient is very likely to reveal the factors making tracheal intubation difficult and thus increasing the likelihood of a traumatized temporo-mandibular joint or mouth. Although laryngoscopes and bronchoscopes incorporating fiberoptic visual devices are invaluable they are usually only employed for extremely difficult patients. ⋯ An atraumatic tracheal intubation will be assisted if the laryngoscope blade to be used is selected on the basis of the anatomic difficulties prescribed by the patient. The Miller, Jackson-Wisconsin, Macintosh, Soper, Bizarri-Guffrida, and Bainton blades together with appropriate handles and fittings comprise a group from which selection can be made.
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Magnesium plays an important role as a cofactor in many of the body's critical functions and reactions. A deficiency or excess of extracellular magnesium can produce significant signs and symptoms. Hypomagnesaemia is a common finding in hospitalised patients, especially those in critical care areas. ⋯ Hypermagnesaemia is often iatrogenic and is more likely in patients with renal dysfunction who are receiving oral or parenteral magnesium. The specific antidote is intravenous calcium. Anaesthetised patients with high serum magnesium levels are at risk from hypotension, potentiation of non-depolarising neuromuscular blockers, postoperative respiratory failure and cardiac arrest.