Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The anaesthetic management of two patients with uncontrolled hyperthyroidism requiring Caesarean section is described. The first patient was diagnosed as hyperthyroid during pregnancy but was resistant to medical management with propylthiouracil (PTU). At 38 weeks' gestation, after optimizing her heart rate with intravenous propranolol, she received an epidural anaesthetic for the Caesarean section. ⋯ Preoperative control of hyperthyroidism, bearing in mind pregnancy and time constraints, is essential. The use of PTU, propranolol, iodine, and glucocorticoids is described in the preparation of the parturient. Fetal and neonatal effects of these drugs are discussed.
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Case Reports
Histamine 2 receptor blocker in the treatment of protamine related anaphylactoid reactions: two case reports.
Two case reports are described of acute anaphylactoid reactions following the administration of protamine to reverse the anticoagulation effect of heparin in patients undergoing coronary artery bypass graft surgery. The administration of cimetidine seemed to reverse the anaphylactoid reaction after conventional treatment with epinephrine, H1 receptor blocker, and steroids had failed. We recommend that H2 receptor blockade be included with other drugs in the treatment of anaphylactoid reactions following protamine, and possibly after anaphylactoid reactions associated with other substances.
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The potency of atracurium was determined in five patients with moderate to severe generalized myasthenia gravis undergoing thymectomy. Train-of-four stimulation was applied to the ulnar nerve and the force of contraction of the adductor pollicis was measured. Cumulative dose-response curves were obtained during thiopentone-nitrous oxide-fentanyl anaesthesia. ⋯ Ten normal patients were studied in the same manner. Their ED50, ED90 and ED95 were 0.13 +/- 0.01, 0.21 +/- 0.02 and 0.24 +/- 0.03 mg.kg-1, respectively. These results demonstrated that, in patients with moderate to severe generalized myasthenia gravis, atracurium was 1.7-1.9 times as potent as in normal individuals.
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Our experience with intravenous regional anaesthesia (IVRA) in 1,906 patients over a period of 20 years has confirmed that this technique is safe and effective. IVRA may be used to provide anaesthesia for surgery involving both the upper and lower extremities. The need for supplemental medication is ordinarily minimal, so the technique is particularly suitable for short procedures in an ambulatory surgery centre. ⋯ A specific protocol for avoiding technical error is presented. Significantly, over a period of 20 years, there has not been any mortality or major morbidity. The incidence of adverse reactions was 1.6 per cent and consisted of minor events such as transient dizziness, tinnitus or mild bradycardia.
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We describe a modification of retrograde guided intubation. With the help of a gliding knot fixed around the side hole of the tracheal tube, we use the catheter to pull and guide the tracheal tube down the larynx and trachea. The technique offers several advantages: it is surprisingly fast, relatively atraumatic, easy to perform, and eliminates most causes of failure.