Canadian Anaesthetists' Society journal
-
Three cases of trismus caused by oropharyngeal sepsis are described where fibreoptic-assisted awake intubation using an oral airway intubator and nebulised lidocaine was safely and successfully achieved.
-
The case histories are presented including the anaesthetic and postoperative management, of two children, a two-year-old with undiagnosed Duchenne muscular dystrophy (DMD) and a three-year-old with known DMD. The child with undiagnosed DMD had no symptoms of DMD and had received halothane twice before, without succinylcholine, with no apparent difficulty. Following an uneventful induction of anaesthesia with halothane, nitrous oxide and O2, succinylcholine resulted in bilateral masseter muscle spasm and then, in rapid sequence, ventricular tachycardia and cardiac arrest. ⋯ Postoperatively his temperature rapidly increased to 38.8 degrees C and then 40.3 degrees C and he became metabolically acidotic. Intravenous administration of dantrolene for 48 hours reduced the temperature and allowed normal recovery and discharge. A postoperative muscle biopsy was consistent with DMD.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Review Comparative Study
Newborn anaesthesia: pharmacological considerations.
-
Randomized Controlled Trial Clinical Trial
Cardiovascular effects of non-depolarizing neuromuscular blockers in patients with coronary artery disease.
To compare haemodynamic responses associated with equipotent doses of muscle relaxants and high dose fentanyl (50 micrograms X kg-1), 40 non-hypertensive patients who were receiving beta adrenergic and calcium channel blocker therapy and undergoing coronary bypass surgery were randomized to four study groups receiving the following: (1) atracurium: 0.4 mg X kg-1, (2) pancuronium: 0.12 mg X kg-1, (3) vecuronium: 0.12 mg X kg-1, or (4) pancuronium-metocurine mixture: (0.4 mg + 1.6 mg X ml-1):1 ml/10 kg. Neuromuscular blockers were injected with fetanyl at induction. Haemodynamics were recorded with the patients awake (baseline), at two minutes post-induction, and at two and five minutes after intubation. ⋯ The pancuronium-metocurine mixture caused tachycardia which was less than, though not significantly different than with pancuronium; however, HR returned to baseline by five minutes with the mixture, but remained elevated with pancuronium (3 vs. 18 per cent, p less than 0.05). SVR fell more on induction with atracurium when compared to vecuronium (-18 vs. 1 per cent, p less than 0.05). These changes in HR or SVR were not accompanied by ECG signs of ischaemia.(ABSTRACT TRUNCATED AT 250 WORDS)