Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Letter Case Reports
[Cerebral pneumatocele after peridural anesthesia in an obstetrical setting].
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Comparative Study Clinical Trial Controlled Clinical Trial
Bupivacaine 0.1% does not improve post-operative epidural fentanyl analgesia after abdominal or thoracic surgery.
Epidural infusions of fentanyl, in a 10 micrograms.ml-1 concentration, combined with bupivacaine 0.1% were compared with epidural infusions of fentanyl alone for postoperative analgesia following abdominal or thoracic surgery. There were no detectable differences between the two groups in analgesia (mean visual analogue scale pain scores ranging between 15-35 mm), average infusion rates of 7-9 ml.hr-1, and serum fentanyl concentrations which reached 1-2 ng.ml-1. ⋯ Of the patients receiving fentanyl and bupivacaine 0.1%, three developed a transient unilateral sensory loss to pinprick and ice, and two of these patients had unilateral leg weakness equal to a Bromage 1 score. The addition of bupivacaine 0.1% does not improve epidural infusions of fentanyl using a 10 micrograms.ml-1 concentration following abdominal or thoracic surgery.
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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.