Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The purpose of this study was to evaluate the effect of prostaglandin E1 (PGE1) on CO2 reactivity during cerebral aneurysm surgery in 37 patients under neuroleptoanaesthesia (NLA). The patients were divided into two groups based on the timing of surgery (A: late surgery B: early surgery). In the early surgery group, aneurysm surgery was performed within three days of subarachnoid haemorrhage (SAH) and in the late surgery group surgery was performed more than four days after SAH. ⋯ Carbon dioxide reactivity was measured before, during and after PGE1 administration. The LCBF did not change throughout the study but CO2 reactivity was greater in Group A (before hypotension: 2.74 +/- 0.85 %.mmHg-1, during hypotension: 2.54 +/- 0.73 % .mmHg-1, after hypotension: 2.59 +/- 1.17 %.mmHg-1) than in group B (before hypotension: 1.54 +/- 0.57%.mmHg-1, during hypotension: 1.56 +/- 0.59 %.mmHg-1, after hypotension: 1.49 +/- 0.42%.mmHg-1) (P less than 0.01). Outcome which was graded by Glasgow Outcome Scale at discharge, was better in Group A (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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The use of intravenous (i.v.) patient-controlled fentanyl analgesia during labour in a parturient with unexplained thrombocytopenia (70 x 10(3).ml-1) is described. The patient self-administered boluses of 25 micrograms of fentanyl with a lock-out interval of ten min. In addition, a concurrent fentanyl infusion of 25 micrograms.hr-1 was given. ⋯ At birth, maternal total plasma fentanyl concentration was 1.11 ng.ml-1, whereas neonatal umbilical total plasma fentanyl concentration was 0.43 ng.ml-1. Newborn plasma protein binding of fentanyl was lower compared to the mother (63% vs 89%). Thus, free fentanyl concentrations (0.16 ng.ml-1) were identical in the mother and newborn at delivery.
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We describe an audit system used in our Medical/Surgical Intensive Care Unit (ICU) during 1989-90. The system emphasizes the integration of data acquisition (database function) with the analysis and use of data (decision function). Resource input (human and technological) included patient demographics, diagnoses, complications, procedures, severity of illness (Apache II), therapeutic interventions (TISS), and nursing workload (GRASP and TISS). ⋯ Limitations of this audit system included the delay (6-9 mos) from ICU admission until data entry, the large number of diagnostic groups in the ICD.9. CM classification, and lack of a documented cause/effect relationship between interventions and complications. This audit system was more useful for utilization management than for quality assurance purposes.
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The accuracy of bolus injections using different sized syringes was studied. A 1 ml bolus was delivered from a 1 ml, 5 ml, 10 ml, and a 20 ml syringe (n = 205). The 1 ml syringe was the most accurate (P less than 0.001) and the bolus delivered was the least variable (P less than 0.001). ⋯ The 5 ml syringe was the most accurate (P less than 0.05) and the 3 ml and 5 ml syringes delivered a bolus with the least variability (P less than 0.001). A 5 ml bolus was delivered from a 5 ml, 10 ml, and a 20 ml syringe (n = 123); in this case there was no significant difference in the accuracy or variability of bolus among the three syringes. We conclude that for accuracy of small volume boluses (less than 5 ml), small-sized syringes should be used.
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Three patients were studied to determine the changes in regional skin temperature and blood flow during extensive sympathetic blockade following total spinal anaesthesia (TSA). Skin temperature was measured at the right upper arm, the right anterior chest at the nipple level, the right hand and the foot, using infrared thermography. ⋯ The mean blood flow in three patients decreased to 26.1, 61.4, 51.7% of the control values 15 min after TSA. Our results indicate that extensive sympathetic nervous blockade during total spinal anaesthesia induces regional different changes in skin temperature and decrease in truncal skin blood flow.