Experience with abdominal field block for laparotomy in critically III patients: a preliminary report - abstract

Patients undergoing laparotomy are usually anaesthetized using conventional general endotracheal anaesthesia with controlled respiration and/or spinal or epidural block. When critically ill patients (ASAIV - V, Gold-mann's score > 26) present for abdominal surgery of short duration, these methods cannot be considered ideal; the associated cardio-respiratory instability and impaired neuromuscular function sometimes necesitate prolonged intubation and controlled respiration in the Intensive Care Unit (ICU). The complications of these were well-known. From June 1987 to November 1988, 25 patients of the above physical status (age range from 3 days to 81 years) had undergone abdominal surgery of short duration (30 to 110 minutes) under general anaesthesia and required ICU admission. Their stay in ICU was from 1 to 36 days. Thirteen died in the first admission, 3 required re-admission and died. At the end of the study, 9 patients were alive. There was clinical, radiological and autopsy evidence of pulmonary infection and ARDS in all these cases. Concurrently 12 patients, of similar physical status and age range ( 2 days to 82 years), were subjected to short abdominal procedures and Caesarean Sections (45 to 111 minutes) under abdominal-field-block. It was supplemented when necessary with "light" (patient arousable to command). All patients were returned to the ward after a short stay in the recovery room. There were 3 deaths, one on the 5th day and 2 on the 8th day; autopsy showed that these were due to the primary pathology. Abdominal-field-block seems a satisfactory technique in poor-risk patients for abdominal procedures of short duration. The avoidance of prolonged intubation, controlled respiration and their complications offer distinct advantages; it is also cost-effective (AU)

A proposed protocol and case report of the anaesthetic management of an HIV-positive patient.

This report describes the anaesthetic management of an HIV-positive patient and proposes a protocol for the management that is suitable for the present working conditions in Jamaica.

A proposed protocol and case report of the anaesthetic management of an HIV-positive patient

This report describes the anaesthetic mangement of an HIV-positive patient and proposes a protocol for the management that is suitable for the present working conditions in Jamaica (AU)

A proposed protocol and case report of the anaesthetic management of an HIV-positive patient

This report describes the anaesthetic management of an HIV-positive patient and proposes a protocol for the management that is suitable for the present working conditions in Jamaica

Continuous supraclavicular brachial plexus block using indwelling cannulae for prolonged analgesia of the upper extremity - abstract

The upper extremity has a specially organized innervation, the brachial plexus, which can be easily blocked by a supraclavicular approach. However, its use for prolonged intra-operative and post-operative analgesia has only been recently explored. The rising costs of general anaesthetic agents and the associated hospital stay, together with the desirability of reducing, or eliminating, the need for systemic narcotic analgesics, prompted us to investigate prolonged brachial plexus analgesia. The method is inexpensive, usually not technically difficult, as safe as conventional local anaesthesia and suitable for both emergency and elective cases. A pilot study on 10 healthy patients was carried out between June and November, 1987. Patients of either sex, from 14 to 47 years old, were included. The three-dimensional approach to the brachial plexus of McIntosh and Mushin, using an intravenous cannula, was employed throughout. After injecting an initial test dose of local anaesthetic, the cannula was left in-situ for further "top up" doses, through a suitable injection port. Xylocaine (1-2 percent) was used for the initial block and bupivacaine, (0.5 percent) for the post-operative maintenance of analgesia. The mean dose of xylocaine for surgical anaesthesia was 5.42 mg/kg body weight, and the mean duration of anaesthesia 137.8 minutes. The mean time lapse to the first "top up" dose was 225.4 minutes and the mean duration of effect to the 2nd "top up" dose 412.5 minutes. No patient required more than two post-operative doses. This pilot study appears to be sufficiently promising to warrant a more extensive trial of prolonged brachial plexus analgesia (AU)