Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Korzeniewski, P.; Lang, S.; Grant, R.; Loader, C.; Vaghadia, H.; Wong, D.; Waters, T.; Merrick, P.; Ali, M.; Dobkowski, W.; Cornelius, T.; Hawkins, R.; Varkey, G.; Claffey, Liam; Plourde, Gilles; Trahan, Michel; Morris, Joan; Dean, Deanne; Yamaguchi, Hiroshi; Harukuni, Izumi; Naito, Hiroshi; Chan, V.; Mati, N.; Seyone, C.; Evans, D.; Chung, F.; Joffe, D.; Plourde, G.; Villemurc, C.; Hong, M.; Milne, B.; Loomis, C.; Jhamandas, K.; Priddy, R.; Archer, D.; Tang, T.; Sabourin, M.; Samanini, N.; Cuillerier, D.; Schuben, Armin; Awad, Issam; Perez-Trepichio, Alejandro; Ebrahim, Zeyd; Bloomfield, Eric; Zexu, Fang; Zhengnua, Gu; Qing, Zou; Balhua, Sung; Miller, D.; Martineau, R.; Wynands, J.; Hill, J.; Knill, R.; Skinner, M.; Novick, T.; McLean, R.; Kolton, M.; Noble, W.; Sullivan, P.; Cheng, D.; Chapman, K.; Ong, D.; Roraanelli, J.; Smallman, Bettina; Nathan, Howard; Murphy, J.; Hall, R.; Moffitt, E.; Hudson, R.; Pascoe, E.; Anderson, B.; Thomson, I.; Kassum, D.; Shanks, A.; Rosenbloom, M.; Sidi, A.; Gehrig, T.; Fool, J.; Rush, W.; Martin, A.; Cooper, P.; Maltby, J.; Johnson, D.; Hurst, T.; Mayers, I.; Wigglesworth, D.; Rose, D.; Kay, J.; Mazer, C.; Yang, H.; Beattie, W.; Doyle, D.; Demajo, Wlifred; Comfort, V.; Code, William; Rooney, Michael; Clark, F.; Sutton, I.; Mutch, W.; Thomson, I.; Teskey, J.; Thiessen, O.; Rosanbloom, M.; Tang, T.; Robblee, J.; Nathan, H.; Wynands, J.; Eagle, C.; Belenkle, I.; Chan, K.; Tyberg, J.; Stockwell, M.; Zintel, T.; Gallagher, G.; Kavanagh, B.; Sandier, A.; Lawson, S.; Chung, F.; Ong, D.; Isabel, L.; Trépanier, C.; Campbell, David; Randall, Thomas; Growe, Gershon; Scarth, Irene; Sawchuk, C.; Ong, B.; Unruh, H.; Horan, T.; Greengrass, R.; Mark, D.; Kitts, J.; Curran, M.; Lindsay, P.; Polis, T.; Coté, Sylvain; Socci, Maria; Wiesel, Saul; Conway, J.; Seyone, C.; Goldberg, J.; Chung, F.; Rose, D.; Cohen, Marsha; Rogers, Kent; Duncan, P.; Pope, W.; Tweed, W.; Biehl, D.; Novick, T.; Skinner, M.; Mathieu, Alix; Villeneuve, Edith; Goldsmith, Charles; Allen, Gregory; Smith, Charles; Pinchak, Alfred; Hagen, Joan; Hudson, J.; Gennings, C.; Tyler, B.; Keenan, R.; Chung, F.; Seyone, C.; Matl, N.; Ong, D.; Powell, P.; Tessler, M.; Kleiman, S.; Wiesel, S.; Tetzlaff, John; Yoon, Helen; Baird, Bruce; Walsh, Michael; Hondorp, Gregory; Wassef, Medhat; Munshi, C.; Brooks, J.; Nimphius, N.; Tweed, W.; Lee, T.; Tweed, W.; Phua, W.; Chong, K.; Lim, E.; Finegan, B.; Coulson, C.; Lopaschuk, G.; Clanachan, A.; Fournier, L.; Cloutier, R.; Major, D.; Sharpe, M.; Wexler, H.; Dhamee, M.; Rooney, R.; Ong, S.; O’Leary, E.; McCarroll, M.; Phelan, D.; Young, T.; Coghlan, D.; O’Leary, E.; Blunnie, W.; Splinter, W.; Splinter, W.; Ryan, T.; Maguire, M.; Bouchier-Hayes, D.; Cunningham, A.; Kamath, M.; Fallen, E.; Murkin, J.; Shannon, N.; Montgomery, C.; Karl, H.; Raymond, Jacques; Drolet, Pierre; Tanguay, M.; Blaise, G.; Garceau, D.; Dumont, L.; Omri, A.; Sharkawi, M.; Billard, V.; Bourgain, J.; Panos, A.; Mazer, C.; Lichtenstein, S.; Bevan, J.; Popovic, V.; Baxter, M.; Donati, F.; Bevan, D.; Bachman, C.; Kopelow, M.; Donen, N.; Umôn, D.; Kemp, S.; Hartley, E.; Sikich, N.; Roy, W.; Lerman, J.; Cooper, Richard; Yentis, S.; Bissonnette, B.; Halpern, L.; Roy, L.; Burrows, F.; Fear, D.; Hillier, S.; Sloan, M.; Crawford, M.; Blssonnette, B.; Sikich, N.; Friedlander, M.; Sandier, A.; Panos, L.; Winton, T.; Benureof, J.; Karski, J.; Teasdale, S.; Cruise, C.; Skala, R.; Zulys, V.; Ong, D.; Chow, F.; Packota, G.; Yip, R.; Bradley, J.; Arellano, R.; Sussman, G.; Sosis, M.; Braverman, B.; Sosis, M.; Ivankovich, A.; Manganas, M.; Lephay, A.; Fournier, Th.; Kadri, N.; Ossart, M.; Sandier, A.; Turner, K.; Wick, V.; Wherrett, C.; Sullivan, P.; Dyck, J.; Varvel, J.; Shafer, S.; Fiset, P.; Balendran, P.; Meistelman, C.; Lira, E.; Sloan, M.; Nigrovic, V.; Banoub, M.; Splinter, W.; Roberts, D.; Rhine, E.; MacNeill, H.; Bonn, G.; Clarke, W.; Noel, L.; Ryan, T.; Moriarty, J.; Bouchier-Hayes, D.; Cunningham, A.; Sandier, A.; Baxter, A.; Norman, P.; Samson, B.; Hull, K.; Chung, F.; Mali, N.; Evans, D.; Cruise, C.; Shumka, D.; Seyone, C.; Leung, Peter; Badner, N.; Komar, W.; Rajasingham, M.; Farren, B.; Vaillancourt, G.; Cournoyer, S.; Hollmann, C.; Breen, T.; Janzen, J.; Crochetiere, C.; McMorland, G.; Douglas, M.; Kamani, A.; Arora, Sunil; Tunstall, M.; Ross, J.; Mayer, D.; Weeks, S.; Norman, P.; Daley, D.; Sandier, A.; Guay, J.; Gaudreault, P.; Boulanger, A.; Tang, A.; Lortie, L.; Dupuis, C.; Backman, S.; Bachoo, M.; Polosa, C.; Moudgil, G.; Frame, B.; Blajchman, H.; Singal, D.; Albert, J.; Ratcliff, A.; Law, J.; Varvel, J.; Hung, O.; Shafer, S.; Fiset, P.; Balendran, P.; Burgess, P.; Doak, G.; Duke, P.; Sloan, P.; Mather, L.; McLean, C.; Rutten, A.; Nation, R.; Milne, R.; Runciman, W.; Somoggi, A.; Haack, Carol; Shafer, Steven; Irish, Craig; Weisleider, Louis; Mazer, C.; Bell, Robert; Dejonckheere, M.; Levarlet, M.; d’Hollander, A.; Taylor, R.; Sikich, N.; Campbell, F.; McLeod, M.; Swartz, J.; Spahr-Schopfer, I.; McIntyre, B.; Roy, W.; Laycock, G.; Mitchell, I.; Morton, N.; Logan, R.; Campbell, F.; Yentis, S.; Fear, D.; Halpem, L.; Sloan, M.; Badgwell, J.; Kleinman, Sam; Yentis, S.; Britton, J.; Hannallah, R.; Schafer, P.; Norden, J.; Splinter, W.; Menard, E.; Derdamezi, J.; Ghurch, J.; Britt, B.; Radde, I.; Sosis, M.; Kao, Y.; Norton, Richard; Volgyesi, G.; Spahr-Schopfer, I.; Sosis, M.; Plum, Mark; Sosis, M.; Smith, C.; Pinchak, A.; Hancock, D.; Owen, P.; McMeekin, J.; Hanson, S.; Cujec, B.; Feindel, C.; Cruz, J.; Boylen, P.; Ong, D.; Murphy, J.; Dupuis, J.; Nathan, H.; Cattran, C.; Wynands, J.; Murphy, J.; Kinley, C.; Sulliyan, J.; Landymore, R.; Robblee, James; Labow, Rosalind; Buckley, D.; Sharpe, M.; Guiraudon, G.; Klein, G.; Yee, R.; Black, J.; Devitt, J.; McLellan, B.; Dubbin, J.; Ehrlich, L.; Ralley, F.; Robbins, G.; Symcs, J.; Bourke, M.; Nathan, H.; Wynands, J.

doi: 10.1007/BF03008442pmid: N/A

Chung, Frances; Seyone, Chanth; Rakowski, Harry

doi: 10.1007/BF03009170pmid: 1989746

We report a case in which a 55-yr-old man undergoing aortocoronary bypass was monitored with electrocardiogram and transoesophageal echocardiogram. Intraoperative electrocardiogram and simultaneous ECG recordings using the Holler monitor showed an ST elevation of greater than 2 mm and new Q wave formation in leads AVF and V5 during skin closure. However, the transoesophageal echocardiogram showed no wall motion abnormalities. No significant haemodynamic abnormalities were observed during the period of intraoperative ECG changes. He was treated with nitroglycerine infusion. Confirmation of a perioperative myocardial infarct was documented by postoperative 12-lead ECG and CPK-MB. A postoperative transthoracic echocardiogram showed a hypokinetic left ventricle with an anteroapical infarct. Thus transoesophageal echocardiography failed to detect an apical wall motion abnormality when the probe was placed at the midpapillary level. This limitation can be overcome by periodically obtaining apical views or by using probes with more than one imaging plane.

Ide, Tohru; Kochi, Tetsuo; Isono, Shiroh; Mizuguchi, Tadanobu

doi: 10.1007/BF03009174pmid: 1899202

The effect of increasing the concentration of sevoflurane anaesthesia on diaphragmatic function was investigated in six mechanically ventilated dogs. Diaphragmatic function was assessed by measuring the transdiaphragmatic pressure (Pdi) generated during bilateral supramaximal stimulation of the cervical phrenic nerves at frequencies of 0.5, 10, 20, 50, and 100 Hz under quasi-isometric conditions. Measurements were performed at 1, 1.5 and 2 MAC concentrations after maintaining stable conditions for one hour. The Pdi-stimulus frequency relationship was compared at each anaesthetic concentration. The sequence of changing anaesthetic depth was altered in random fashion among animals. The Pdi amplitude generated by single twitch (0.5 Hz) was unchanged at the three concentrations. In addition, no change in Pdi during 10, 20, 50 Hz stimulation was noted at any of the three levels of anaesthesia. By contrast, Pdi with 100 Hz stimulation during 2 MAC sevoflurane exposure (28.1 ±5.0 cmH2O) decreased below Pdi levels seen at 1 and 1.5 MAC (35.3 ±4.3 cmH2O and 31.5 ±4.3 cmH2O, respectively) (P < 0.05). From these results, we conclude that sevoflurane impairs diaphragmatic function in deep anaesthesia.

Gin, Tony; Yau, Gordon; Chan, Kelvin; Gregory, Michael; Oh, Teik

doi: 10.1007/BF03009160pmid: 1989737

The disposition of propofol was studied in women undergoing elective Caesarean section. Indices of maternal recovery and neonatal assessment were correlated with venous concentrations of propofol. After induction of anaesthesia with propofol 2.0 mg · kg−1, ten patients received propofol 6 mg · kg−1 · hr−1 with nitrous oxide 50 per cent in oxygen (low group) and nine were given propofol 9 mg · kg−1 · hr−1 with oxygen 100 per cent (high group). Pharmacokinetic variables were similar between the groups. The mean ± SD Vss = 2.38 ± 1.16 L · kg−1, Cl = 39.2 ± 9.75 ml · min−1kg−1 and t1/2β= 126 ± 68.7 min. At the time of delivery (8–16 min), the concentration of propofol ranged from 1.91–3.82 μg · ml−1 in the maternal vein (MV), 1.00–2.00 μg · ml−1 in the umbilical vein (UV) and 0.53–1.66 μg · ml−1 in the umbilical artery (UA). Neonates with high UV concentrations of propofol at delivery had lower neurologic and adaptive capacity scores 15 minutes later. The concentrations of propofol were similar between groups during the infusion but they declined at a faster rate in the low group postoperatively. Maternal recovery times did not depend on the total dose of propofol but the concentration of propofol at the time of eye opening was greater in the high group than the low group (1.74 ± 0.51 vs 1.24 ± 0.32 μg · m−1, P < 0.01). The rapid placental transfer of propofol during Caesarean section requires propofol infusions to be given cautiously, especially when induction to delivery times are long.

Durand, Pierre-Georges; Lehot, Jean-Jacques; Foëx, Pierre

doi: 10.1007/BF03009168pmid: 1989744

Verapamil was the first calcium-channel blocker (CCB). It has been used since 1962 in Europe then in Japan for its antiarrhythmic and coronary vasodilator effects.1 The CCB have become prominant cardiovascular drugs during the last 15 years. Many experimental and clinical studies have defined their mechanism of action, the effects of new drugs in this therapeutic class, and their indications and interactions with other drugs. Due to the large number of patients treated with CCB it is important for the anaesthetist to know the general and specific problems involved during the perioperative period, the interactions with anaesthetics and the practical use of these drugs.

Lang, Scott

doi: 10.1007/BF03009183pmid: N/A

Frenette, Luc; Boudreault, Daniel; Guay, Joanne

doi: 10.1007/BF03009167pmid: 1989743

The purpose of this study was to examine the effects of interpleural bupivacaine on analgesia and ventilatory capacity after cholecystectomy. Forty-two patients undergoing elective cholecystectomy were randomly assigned to two groups: one to receive interpleural administration of bupivacaine-adrenaline mixture (Croup 1 = 22 patients) and the other standard administration of intramuscular meperidine (Group 2 = 20 patients) for postoperative pain relief. The intensity of pain was evaluated by a visual analogue scale (VAS) preoperatively as well as at 2, 8, 24 and 48 hr postoperatively. At the same time, FVC and FEV1.0 measurements were obtained for all patients. The group given interpleural bupivacaine had better pain relief withmean VAS of 0.6 ± 0.9 (mean ± SD) 1.1 ± 1.4, 0.6 ± 0.9 and 0.8 ± 1.2 compared with 5.2 ± 2.2. 5.8 ± 2.7. 5.5 ± 2.2 and 4.5 ± 1.8 for patients receiving meperidine (P < 0.001). The patients in Group 1 also had larger FVC and FEV than those in Group 2: FVC 22 ± 14.5 per cent vs 32 ± 15.2 per cent (P < 0.005), FEV1.025 ± 15.5 vs 38 ± 14.8 per cent (P < 0.001) (mean ± SD). We conclude that the interpleural analgesia can achieve better pain relief with greater ventilatory capacity than a standard analgesic regimen in the first two days after cholecystectomy.

Bevan, David

doi: 10.1007/BF03008437pmid: 2060078

Akhtar, T.

doi: 10.1007/BF03009184pmid: 1989734

Vincent, Jean

doi: 10.1007/BF03008433pmid: 2060074