Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The alkalinization of certain local anaesthetics with sodium bicarbonate hastens the onset of epidural analgesia. Increases in both the pH and PCO2 of the local anaesthetic are necessary to hasten onset. However, carbon dioxide can diffuse from local anaesthetic solutions following alkalinization with sodium bicarbonate and change both the pH and PCO2 of the mixture. ⋯ The pH and PCO2 of each solution were measured at time 0 and at 5, 10, 15, 20, 30, 40, 50 and 60 min intervals. The solutions were placed in containers as follows: 30 ml in 40 ml containers, 10 ml in 40 ml containers, 10 ml in 13 ml containers, and 10 ml in polypropylene syringes. The pH and PCO2 increased following alkalinization but gradually decreased in all containers except in polypropylene syringes.
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Few rural hospitals offer obstetric epidural analgesia services and of those that do, there is a paucity of information about these anaesthetics. A retrospective review was conducted of all obstetrical epidurals from 1984-1988 in an 85-bed hospital in Saskatchewan to examine the indications, complications, and infant outcomes. During that period there were 1224 deliveries. ⋯ Caesarean sections numbered 309: 183 (59.3%) were with epidural analgesia of which 69 were urgent and 114 elective. The overall complication rate was 23% with the most important being hypotension (12%), dural punctures (1.8%), inadequate block requiring an intravenous supplement (4.0%) or a general anaesthetic (3.1%). Infant outcomes were favourable except for two unrelated intra-uterine deaths preceding labour.
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Operative charts were reviewed in 86 patients with Charcot-Marie-Tooth disease, a condition characterized by chronic muscular denervation. A total of 161 surgical procedures was performed. ⋯ Succinylcholine and malignant hyperthermia triggering agents were used in 41 (48%) and 77 (90%) patients, respectively, without untoward effects. Contrary to previous reports, this survey supports the safe use of succinylcholine and MH triggering agents in this disease.