Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Stanski, Donald

doi: 10.1007/BF03008434pmid: 2060075

Lam, Arthur

doi: 10.1007/BF03008435pmid: 2060076

Patients with spinal cord injuries represent a complex problem and anaesthetic challenge, and optimal anaesthetic management depends on thorough understanding of the pathophysiology and pharmacology involved.

Amar, David; Brodman, L.; Winikoff, Steven; Hollinger, Ingrid

doi: 10.1007/BF03009163pmid: 1989739

This randomized controlled trial compared the compliance of a blow-by oxygen method with the standard face mask by children recovering from anaesthesia. The rate at which a face mask was rejected when applied to infants and children in PACU was compared with that of a proposed “hose” method. The efficacy of the “hose” as a method of oxygen supplementation in children at low and high risk for developing postoperative hypoxaemia was also compared with the face mask. Using a Nellcor N-200 pulse oximeter, 66 infants and children (mean age 2.3 yr, range 2 mo-6yr) were continuously monitored for 30 min upon arrival in the PACU. Patients were randomized to receive oxygen supplementation with either the face mask or the proposed “hose“ method. The results showed a greater than 80 per cent rejection of the face mask in contrast to 100 per cent compliance with the “hose” method. The SaO2 measurements following 5, 15 and 30 min of O2 supplementation with the hose were all significantly higher than the SaO2 measurements obtained on room air upon arrival to the PACU. Patients with pre-existing cardiopulmonary disease had a 20 per cent incidence of arterial oxygen desaturation upon arrival to the PACU versus 2.1 per cent of patients with no pre-existing disease. It is concluded that the “hose” is associated with high patient compliance and is effective in the PACU in increasing the SaO2 in children at low or high risk of developing postoperative hypoxaemia.

Doyle, D.

doi: 10.1007/BF03009179pmid: N/A

Manninen, Pirjo

doi: 10.1007/BF03008440pmid: 2060069

Providing anaesthesia to patients outside the operating room will be a satisfying experience if one adheres to the same standards of care as in the operating room and one has thoroughly planned in advance the management of the patient.

Withington, Davinia; Ramsay, James; Saoud, A.; Bilodeau, Jean

doi: 10.1007/BF03009157pmid: 1899203

Weaning of patients from IPPV after cardiopulmonary bypass (CPB) is usually monitored by frequent arterial blood gas analysis. Non-invasive monitoring has the advantage of providing continuous and instantaneous information and could reduce the frequency of arterial blood gas sampling. Twenty patients were studied to determine the reliability of capnometry and pulse oximetry in this situation. The effects of hypothermia and moderate haemodynamic instability were examined. A further 40 patients were then weaned using non-invasive monitoring. Correlation between PaCO2 and PETCO2 was 0.64–0.79 for the mass spectrometer and 0.67–0.81 for the infrared analyser. No clinical problems arose. The detection rate for mild hypercarbia was 78.6 per cent and 50 per cent for hypoxia. Possible reasons for this are discussed. Once CO2 and O2 gradients are established, pulse oximetry and capnometry provide sufficiently reliable monitoring to enable weaning from IPPV, with the advantage of continuous display, and allow a reduction in the use of arterial blood gas analyses.

Palacios, Quisqueya; Jones, Monica; Hawkins, Joy; Adenwala, Jayshree; Longmire, Stephen; Hess, Kenneth; Skjonsby, Barbara; Morrow, Dean; Joyce, Thomas

doi: 10.1007/BF03009159pmid: 1989736

Epidural butorphanol 1, 2 and 4 mg were compared with morphine, 5 mg, for postoperative analgesia in 92 consenting, healthy, term parturients who had undergone Caesarean section under epidural lidocaine anaesthesia in a randomized double-blind study. Postoperative pain was assessed using a visual analogue scale and recorded with heart rate, blood pressure and respiratory rate. The demographic characteristics, and the incidences of primary and repeat Caesarean sections, were not different among the four treatment groups. At 15, 30, 45 and 60 min after treatment the median pain scores following butorphanol were similar and lower than those following morphine (P < 0.05). Calculated median percentage pain relief values for butorphanol were higher than morphine at each of these times (P < 0.05). At 90 min and 2 hr the pain scores and pain relief values were similar. Beyond 45 min the number of patients requesting supplemental medication and dropping out of the study increased progressively in both the butorphanol and morphine treated patients. The attrition profiles for butorphanol were different from morphine (P < 0.01). The median time in the study was > 24 hr for morphine, and 3, 2.5 and 4 hr for butorphanol, 1, 2 or 4 mg, respectively. No patient developed a clinically important change in heart rate or blood pressure, and none experienced a decrease in respiratory rate below 12 breaths · min−1. One of 69 patients (1.4 per cent) who received butorphanol developed pruritus compared with ten (43 per cent) of 23 patients who received morphine. The global assessments of the adequacy of analgesia were indistinguishable between morphine and butorphanol. Epidural butorphanol provides safe, effective postoperative analgesia, has a prompt onset, and a limited duration.

Maltby, J.; Amatya, R.; Rana, N.; Shrestha, B.; Tuladhar, T.; McCaughey, T.

doi: 10.1007/BF03009172pmid: 1989728

In 1985 a diploma program in anaesthesia was established in Kathmandu, Nepal, as a joint venture between the Institute of Medicine in Kathmandu and the University of Calgary. Development of the program and of the specialty in the capital city of Kathmandu was continuously documented during the next five years by local and visiting faculty. In 1990 teams of two Nepali and one Canadian anaesthetist also conducted a survey of each of the seven 50–100 bed zonal hospitals which did not previously have a trained anaesthetist and which are now staffed by graduates of the diploma program. In 1985 Nepal, with a population of 16 million, had seven trained Nepali anaesthetists all of whom worked in two hospitals in Kathmandu. By the end of 1989, 19 physicians had graduated. Seven of these continue to work in Kathmandu hospitals. nine work in zonal hospitals throughout the country and two are taking higher anaesthesia training in the United Kingdom. Additional Nepali anaesthetists have returned from training abroad, and the Society of Anaesthesiologists of Nepal, which joined the World Federation of Societies of Anaesthesiologists in 1988, now has 34 members. An annual anaesthesiology symposium is held, and weekly clinical meetings are organized in the major hospitals in Kathmandu. Anaesthetists who work in the zonal hospitals have limited supplies of drugs and equipment and opportunities for continuing medical education are virtually nonexistent. Despite these problems, the establishment of an ongoing anaesthesia training program based in Nepal has had a dramatic impact on the number of trained anaesthestists in the country, and has improved the morale of the anaesthetists and the image of the specialty of anaesthesia in that country.