Canadian Anaesthetists' Society journal
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Hospitals and anaesthetists in British Columbia were surveyed by means of questionnaires to assess patterns of obstetric anaesthesia practice, qualifications and numbers of obstetric anaesthesia personnel, hospital obstetric facilities and facilities and protocols for neonatal resuscitation. It was apparent that a large proportion of the obstetric anaesthesia service in this province was being provided by physicians who were not trained, nor certified, as anaesthesia specialists. Preanaesthetic assessment in the obstetric units differed in attitude and practice from the standards expected in the general operating rooms. ⋯ Post-anaesthetic recovery facilities in obstetric units were conspicuously deficient, even in the larger hospitals. The majority of community hospitals lacked written protocols for neonatal resuscitation; and the number of institutions reporting that the neonatal heart rates and temperatures were not routinely monitored is of concern. It is recommended that minimum standards for training in obstetric anaesthesia should be clearly defined; and provision should be made for revision and upgrading of knowledge and skills for physicians practicing anaesthesia in smaller community hospitals.
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The prophylactic effectiveness of a small "self-taming" dose of succinylcholine (0.1 mg X kg-1), of d-tubocurarine (0.05 mg X kg-1), and of pancuronium (0.02 mg X kg-1) on succinylcholine-induced fasciculations and myoglobinaemia was studied in 64 healthy children (ages two to nine years), anaesthetized with halothane, nitrous oxide and oxygen. Serum myoglobin was analyzed by radioimmunoassay and taken as a tracer of muscle damage. No correlation was found between the serum levels of myoglobin and the incidence of muscle fasciculations. ⋯ The pancuronium pretreated group presented less variable values of serum myoglobin which, when compared to the control group, had a more significant p value (p less than 0.001) than for d-tubocurarine pretreated group (p = 0.003). Muscle fasciculations and increased myoglobin levels were observed in children less than four years old who received succinylcholine. The prophylaxis of acute rhabdomyolytic renal failure due to succinylcholine (seven cases reported in the medical literature) is considered.
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Over the past three years, 36 anaesthetics were administered to 27 patients with achondroplastic dwarfism. Twenty-four patients underwent craniectomy for foramen magnum stenosis. Sixteen of the operations were undertaken in the sitting position with nine incidents of venous air embolism (VAE), all of which occurred in patients under 12 years of age. ⋯ Airway management and laryngoscopy were not difficult and we found that endotracheal tube size was best predicted by the patient's weight and not age. Blood loss was 38 +/- 9 mg X kg-1 in the prone position (n = 8) and 18 +/- 4 mg X kg-1 in the sitting position (n = 16), and was related to the surgical procedure rather than to dwarfism. Our data indicate that complications are more likely to occur in the sitting position, and that these complications are of a serious nature, and every precaution should be taken to avoid their occurrence.
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Oesophageal perforation, due to a difficult endotracheal or nasogastric intubation occurred in a 49-year-old female. Perforation of the oesophagus is a rare complication of intubation of the trachea or oesophagus. Endotracheal intubation alone is most often blamed for iatrogenic oesophageal trauma following surgery. ⋯ Plain roentenograms of the neck and a contrast media swallow will confirm the diagnosis. Treatment consists of massive antibiotic therapy followed by surgical repair and drainage of the area. Mortality ranges from 10-15 per cent with early diagnosis to 50 per cent if surgery is delayed.
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During a coronary artery bypass operation arterial blood pressure measured with a Bentley Trantec model 800 transducer increased erroneously while continuous electrocautery was being used. This phenomenon has recurred infrequently, with fictitious hypotension being observed in one patient. To reproduce the problem of pressure offset during electrosurgery a bench test demonstrated that with peak to peak voltage of 20 volts from the electrosurgical unit, three of seven Bentley transducers had offsets as much as +/- 50 mmHg. It is important for anaesthetists to determine if electrosurgery units are functioning before treating apparent pressure drifts.