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At least 523 records · Page 29Linked to original sources
PubMed1992

Anaesthesia for Charcot-Marie-Tooth disease: a review of 86 cases.

Operative charts were reviewed in 86 patients with Charcot-Marie-Tooth disease, a condition characterized by chronic muscular denervation. A total of 161 surgical procedures was performed. Major complications were few, and only one operative death occurred, unrelated to anaesthesia. Succinylcholine and malignant hyperthermia triggering agents were used in 41 (48%) and 77 (90%) patients, respectively, without untoward effects. Contrary to previous reports, this survey supports the safe use of succinylcholine and MH triggering agents in this disease.

Adolescent↗
PubMed1993

The laryngeal mask airway and prolonged balanced regional anaesthesia.

The purpose of this paper is to report an eight-hour operation in which anaesthesia was provided by a combination of continuous epidural analgesia and light general anaesthesia administered via a laryngeal mask. During the perioperative period, the respiratory system was monitored with arterial blood gas and thoraco-abdominal movement analyses. There was no deterioration in respiratory function nor evidence of respiratory fatigue. We suggest that this is a suitable technique in fasting healthy patients undergoing prolonged surgery to the extremities.

Adult↗
PubMed1995

Incidence of malignant hyperthermia reactions in 2,214 patients undergoing muscle biopsy.

To determine the incidence of malignant hyperthermia (MH) reactions after trigger-free anaesthesia in a large population of MH-susceptible (MHS) patients, the charts of 2,214 patients who underwent elective muscle biopsy for malignant hyperthermia were reviewed. Either general or regional anaesthesia with non-triggering drugs was used. For general anaesthesia, the trachea was intubated in the absence of muscle relaxants. The halothane/caffeine contracture test was performed on the biopsied muscle. Suspected MH reactions were identified according to their site of occurrence (in the operating room, recovery room or ward). Ninety-seven percent of patients received a general anaesthetic; 3% received a regional anaesthetic or field block. Of the 2214 patients whose muscles were biopsied, 1082 patients were biopsy-positive for MH. Five patients in whom MH reactions were diagnosed in the recovery room were all subsequently proved to be biopsy-positive for MH. Four of the five received intravenous dantrolene as part of their therapy; the fifth received only symptomatic therapy as parenteral dantrolene was not commercially available. All patients recovered completely from their reactions. We conclude that the incidence of MH reactions in biopsy-positive patients who receive a trigger-free anaesthetic for minor surgery is small (0.46%, (0.15-1.07%, 95% CI)). These reactions occur in the immediate postoperative period.

Adolescent↗
PubMed1989

Intravenous regional anaesthesia (Bier block): review of 20 years' experience.

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. Yet, prolonged surgery may be performed using a "continuous technique." Although various local anaesthetic agents may be used to induce IVRA no drug has been demonstrated to be superior to lidocaine. The major cause of failure of the technique or serious adverse effects is technical error. 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.

Adult↗
PubMed1989

Anaesthesia for hip surgery in the elderly.

Surgical repair of hip fracture and total hip arthroplasty are primarily performed on elderly patients. Patients presenting for hip fracture surgery have a high prevalence of preoperative medical problems and may require medical stabilization before surgery. Regional anaesthesia for hip fracture repair may be contraindicated due to perioperative pharmacologic prophylaxis for deep venous thrombosis. The use of regional anaesthesia increases the magnitude and frequency of hypotensive episodes when compared with general anaesthesia. Intraoperative blood losses, averaging 250-300 ml, are not affected by anaesthetic technique. Following hip fracture surgery under spinal anaesthesia, patients exhibit better oxygenation in the early postoperative period than those after general anaesthesia. The frequency of postoperative confusion is unrelated to anaesthetic technique. The incidence of deep venous thrombosis is reduced following spinal anaesthesia as compared with general anaesthesia. The one-month mortality rate, approximately eight per cent, is unrelated to anaesthetic technique. Spinal, epidural and general anaesthesia have been used successfully for total hip arthroplasty. Intraoperative blood loss of 0.5-1.5 litres is reduced with regional anaesthesia. General anaesthesia with controlled hypotension also significantly reduces blood loss. Intraoperative instability with hypoxaemia, hypotension and cardiac arrest may follow impaction of the femoral prosthesis and are related to absorption of acrylic cement monomers and pulmonary embolism of fat, air, and platelet-fibrin aggregates. Postoperative deep venous thrombosis is common and the incidence may be reduced with epidural anaesthesia. Operative mortality is less than one per cent and pulmonary embolism is the commonest cause of death.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

Anaesthetic management of patients with sleep apnoea syndrome.

PURPOSE: Sleep apnoea syndrome (SAS) is a relatively common, potentially fatal, disorder. Patients with SAS exhibit repetitive, often prolonged episodes of apnoea during sleep, with serious nocturnal and diurnal physiologic derangements. Several anecdotal reports and clinical studies have documented anaesthetic-related occurrence of fatal and near-fatal respiratory complications in these patients. The purpose of this article is to outline the potential problems encountered in anaesthetic management of adult SAS patients, and to suggest a practical approach for anaesthesia both for incidental and specific procedures. PRINCIPAL FINDINGS: SASs have many implications for the anaesthetist. First, SAS patients are exquisitely sensitive to all central depressant drugs, with upper airway obstruction or respiratory arrest occurring even with minimal doses. Thus sedative and opioid premedication should be omitted as should the intra and postoperative use of opioids be limited or avoided. All anaesthetic drugs should be administered by titration to desired effect, preferably using short-acting drugs. When feasible, continuous regional anaesthesia using a catheter is the technique of choice. Where possible nonopioid analgesics or local anaesthetics should be used for postoperative analgesia. Perioperative monitoring for apnoea, desaturation, and dysrhythmias is essential. Secondly, SAS patients have a potentially difficult airway. Awake intubation is the safest approach to airway control. Extubation should only be tried in the fully conscious patient with intact upper airway function and under controlled situations. Thirdly, the cardiorespiratory complication of SAS and the presence of associated diseases can adversely influence anaesthetic management. CONCLUSION: Perioperative risks attending SAS patients emphasize the importance of their detection, perioperative evaluation and planning.

Adult↗
PubMed1997

Risk of unanticipated intraoperative events in patients assessed at a preanaesthetic clinic.

PURPOSE: To determine the risk of unanticipated intraoperative events (UIE) in patients assessed at a preanaesthetic clinic compared with those not assessed at the clinic. METHODS: Preoperative and intraoperative data were collected on 6130 elective surgical patients by procedural anaesthetists over a 12-month-period at an Australian tertiary referral hospital. The procedural anaesthetists rated the level of preparation and identified predefined unanticipated intraoperative events. A logistic regression model was used to identify significant risk factors of UIE and was further validated on another sample of 482 patients (one month) by a goodness-of-fit test. RESULTS: Of the 6130 elective surgical patients, 2000 (33%) had been assessed at the preanaesthetic clinic. There was a greater proportion of ASA II to IV patients seen at the clinic than patients not assessed at the clinic (chi 2(3) = 689.92, P < 0.001). Nonclinic patients were more likely to be inadequately prepared than clinic patients (RRunadjusted = 1.61, 95% CI: 1.25 to 2.04, P < 0.001). The overall incidence of intraoperative events was 4.14% (95% CI: 3.64% to 4.64%). Despite adjusting for the preparation level, type of anaesthesia, admission category, ASA physical status and duration of anaesthesia, clinic patients were 1.94 (95% CI: 1.42 to 2.64) times more likely to experience an UIE than nonclinic patients (P < 0.001). CONCLUSION: Although clinic patients were more often optimally prepared, their adjusted risk of UIE was higher than nonclinic patients. The procedural anaesthetist needs to be vigilant with these high risk patients, even if they have been assessed at a preanaesthetic clinic.

Adult↗
PubMed1999

Control of shivering under regional anesthesia in obstetric patients with tramadol.

PURPOSE: Tramadol in a dose of 1 mg x kg(-1) iv is effective in the treatment of shivering after general anesthesia. The current study aimed to investigate (1) whether tramadol was equally effective for shivering under regional anesthesia in obstetric patients and (2) whether effective treatment could be achieved with lower doses. METHODS: In a randomised, double-blind study, 36 obstetric patients who shivered during Cesarean section under regional anesthesia and who requested anti-shivering treatment were allocated to one of three groups for iv treatment: Group T0.5 received tramadol 0.5 mg x kg(-1) (n = 12), Group T0.25 tramadol 0.25 mg x kg(-1) (n = 13) and Group NS normal saline 0.05 ml x kg(-1) (n = 11). Treatment efficacy was evaluated subjectively by the parturient as no improvement, slight improvement, or marked improvement. The attending anesthesiologist who was blinded also independently noted the time elapsed from treatment to the time shivering subsided. Side effects such as nausea, vomiting or sedation and Apgar scores of the newborn were also noted. RESULTS: Eighty percent of parturients in Group T0.5 and 92% in Group T0.25 were judged by observers to have shivering controlled compared with 27% in Group NS (P < 0.001). The response rates of Group T0.5 and Group T0.25 were not different. There was no increased incidence of side effects in the treatment groups. CONCLUSION: We conclude that tramadol iv was effective in the treatment of intraoperative shivering during regional anesthesia for Cesarean section. There was no demonstrable difference in response rate or incidence of side effects between the two doses of 0.5 mg x kg(-1) and 0.25 mg x kg(-1).

Adult↗
PubMed1999

Non-alkalinized and alkalinized 2-chloroprocaine vs lidocaine for intravenous regional anesthesia during outpatient hand surgery.

PURPOSE: Chloroprocaine should be an ideal agent for intravenous regional anesthesia (IVRA) because of its rapid onset and ester hydrolysis. Raising the pH of local anesthetics may increase the speed of onset and the intensity of nerve blocks. We compared plain and alkalinized 2-chloroprocaine 0.5% with lidocaine for IVRA. METHODS: In two separate double-blind studies, 78 patients scheduled for daycare hand surgery were randomized to receive 40 mL plain 2-chloroprocaine 0.5%, alkalinized 2-chloroprocaine 0.5% or lidocaine 0.5% for IVRA. Time to sensory and motor block, need for supplemental analgesia, and side effects were compared. RESULTS: There was no difference in time to sensory or motor block in either group. Patients who received plain chloroprocaine required more supplemental opioid and had a higher incidence of metallic taste and of hives than patients who received lidocaine (P < 0.05). Comparing alkalinized chloroprocaine with lidocaine, there was no difference found with respect to opioid supplementation, CNS side effects, or incidence of hives. CONCLUSION: In conclusion, alkalinized chloroprocaine was found to be an effective agent for IVRA but no benefit over lidocaine was detected. Plain chloroprocaine for IVRA produced more minor side effects than lidocaine.

Adult↗
PubMed1999

Patient flow in the Post Anesthesia Care Unit: an observational study.

PURPOSE: Anesthesiologists are constantly striving for improvement in health care delivery. We assessed the patient flow in the Post Anesthesia Care Unit (PACU) to determine if patients are being transported out of the PACU when ready. METHODS: A University student recorded the flow of 336 patients who recovered in our Post Anesthesia Care Unit. The corresponding nursing and orderly complements were recorded. If a delay arose between the time the patient was deemed fit for discharge by the PACU nurse and the time the patient was transported from the PACU, the student determined the duration and cause(s) of the delay. RESULTS: The number of patients, nurses, and orderlies increased from three to twelve, three to seven, and one to two respectively throughout the elective working day. Seventy-six per cent of patients studied were delayed in transport from the PACU, with 26% of patients waiting 30 min. The average delay in discharge for patients increased during the day from 0 to 65 +/- 54 min from the time of fit for discharge, as determined by the PACU nurse, until transport. Five causes were identified as contributing to the delay: orderly too busy (41%), awaiting Anesthesia assessment (36%), Post Anesthesia Care Unit nurse too busy (15%), receiving floor not ready (6%), and patient awaiting radiographic interpretation (2%). CONCLUSION: Our study has shown that system errors unnecessarily prolongs the stay of patients in the PACU.

Anesthesia Recovery Period↗