British journal of anaesthesia
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Antagonists of the N-methyl-D-aspartate (NMDA) subtype of glutamate receptors have been shown not only to have neuroprotective effects but also to exhibit neurotoxic properties. In this study, we used c-Fos, a protein product of an immediate early gene, as a marker of neuronal injury to compare the neuroprotective effects of xenon and the neurotoxic properties of xenon, nitrous oxide, and ketamine, three anaesthetics with NMDA receptor antagonist properties. ⋯ Uniquely amongst anaesthetics with known NMDA receptor antagonist action, xenon exhibits neuroprotective properties without co-existing neurotoxicity. The reason why ketamine and nitrous oxide, but not xenon, produce neurotoxicity may involve their actions on dopaminergic pathways.
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The laryngeal tube is a new alternative for securing the airway. After adequate oxygenation, insertion of a tracheal tube is still required in many situations. In such circumstances, fibreoptic placement of a tube exchange catheter after placement of the laryngeal tube is possible before tracheal intubation. Throughout the procedure, oxygen administration can continue via the laryngeal tube, the tube exchange catheter and the tracheal tube. ⋯ This technique is an important alternative for airway management and provides a significant degree of patient safety.
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We present the cases of three women who, within a 6-month period, suffered post-partum generalized tonic-clonic seizures. All had received an epidural in labour for analgesia and were subsequently diagnosed as suffering from postdural puncture headache. ⋯ All made satisfactory recoveries and were discharged home. None displayed classical patterns suggestive of pre-eclampsia, meningitis, cortical venous thrombosis or any other pathological process that might explain these events adequately, and the specific precipitating factors were left unidentified.
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Platelet dysfunction is an important cause of excessive bleeding after cardiac surgery. We assessed two platelet function point-of-care tests: the platelet function analyser (PFA-100) and the Hemostatus(TM) in patients with and without excessive bleeding after cardiac surgery with cardiopulmonary bypass. ⋯ Patients bleeding excessively in the ICU had abnormal measurements in point-of-care tests without a dramatic decrease in aggregation. Except for patients with increased risk of postbypass bleeding, point-of-care tests are not useful for routine use after cardiac surgery.
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There has been recent concern in the media over the possible detrimental effects of herbal medicines on the perioperative period. Perceived by the public as 'natural' and therefore safe, herbal remedies may have led to adverse events such as myocardial infarction, bleeding, prolonged or inadequate anaesthesia and rejection of transplanted organs. In addition, herbal remedies can interact with many drugs given in the perioperative period. In this article we summarize the potential perioperative complications that can occur. ⋯ Self-administration of herbal medicines is common in patients presenting for anaesthesia. Because of the potential for side-effects and drug interactions it is important for anaesthetists to be aware of their use.