Pregnancy in women with Noonan syndrome: report of two cases.

Background: Noonan syndrome is similar phenotypically to Turner syndrome, accounting for one in 1000-2500 live births. Two thirds of patients have cardiac anomalies, half with pulmonary stenosis. Two cases of Noonan syndrome in pregnancy are presented, each woman with a different cardiac anomaly.

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims.

Purpose: To review the pattern of malpractice litigation related to regional anesthesia in Canada.

Source: The Canadian Medical Protective Association (CMPA) provided with information about all anesthesia claims that closed in the years 1990-1997.

Principal Findings: In the period 1990-97 there were 7,909 closed legal actions involving all CMPA members (56,000).

Combined spinal epidural anaesthesia in a primigravida with valvular heart disease.

Purpose: This is the first report describing combined spinal epidural anaesthesia for labour and unexpected Caesarean section in a patient with mitral and aortic stenosis and insufficiency.

Clinical Features: The patient was a 30-yr-old GIPO with a history of rheumatic fever. She had moderate stenosis and insufficiency of the mitral and aortic valves.

Pulmonary hypertension and pregnancy: a series of eight cases.

This is the report of a series of eight patients with pulmonary hypertension (primary and secondary) who delivered at the McMaster University Medical Centre between 1978 and 1987. Seven of the eight patients delivered vaginally and had a successful outcome. The eighth patient was admitted as an emergency and died shortly after Caesarean section under general anaesthesia, performed to save the infant.

Placental transfer of local anaesthetics in the premature sheep fetus.

This study was designed to test whether there is any difference in the placental transfer of bupivacaine or lidocaine in the early compared to the late preterm maternal/fetal sheep preparation; and whether the premature lamb fetus reacts to a steady state local anaesthetic infusion differently from the same lamb near term. Eleven ewes were studied in two groups receiving bupivacaine (group A) or lidocaine (group B). Hysterotomy and insertion of fetal and maternal lines were performed at 110 days gestation, and studies were repeated weekly using the same local anaesthetic until delivery.

Postoperative pain relief and hospital stay after total esophagectomy.

Intraoperative and postsurgical epidurally administered pain relief is associated with reduced morbidity. We reviewed the charts of 19 patients who had total esophagectomy to see whether the method of postoperative pain relief influenced the length of hospital stay and cost of the procedure. The patients received either intravenous (group M) or epidural (group E) morphine for postoperative pain.

A comparative study of continuous and intermittent epidural analgesia for labour and delivery.

This study compares a continuous infusion technique with intermittent "top-up" doses using 0.25 per cent bupivacaine for epidural analgesia for labour and delivery in healthy primiparous patients. Sixty women were randomized into two groups, A (continuous) and B (intermittent).

Intramuscular cimetidine and ranitidine as prophylaxis against gastric aspiration syndrome--a randomized double-blind study.

Preoperative cimetidine 300 mg or ranitidine in 50 and 100 mg doses were administered intramuscularly to 120 patients in a randomized double-blind study. The volume and pH of gastric aspirate samples obtained after tracheal intubation and before extubation were measured. The pH of gastric aspirate was higher following ranitidine 100 mg than ranitidine 50 mg or cimetidine 300 mg at both intubation and extubation (p = 0.

Fetal blood and tissue PO2 during maternal oxygen breathing.

The effect of 100% oxygen breathing on fetal blood and tissue PO2 was examined in chronically catheterised fetal sheep of 12 pregnant ewes. Blood PO2 was monitored with intravascular polarographic electrodes and tissue PO2 with galvanic electrodes implanted in various tissues. In non-acidotic healthy fetuses, oxygen breathing increased fetal PO2 by 30% within 3 min in arterial blood and within 5 min in tissues.

A double-blind comparison of cimetidine and ranitidine as prophylaxis against gastric aspiration syndrome.

Preoperative cimetidine, ranitidine, or placebo were administered, orally or intravenously to 190 patients in a double-blind study. The volume and pH of gastric aspirate samples, obtained after tracheal intubation and before extubation, were measured. Both cimetidine and ranitidine produced higher mean pH levels and thus fewer patients "at risk" should gastric aspiration occur (pH less than or equal to 2.

Control of breathing after fentanyl and Innovar anaesthesia.

Ventilation (VI), end-tidal (PCO2), mixed venous (PvCO2) and the ventilatory response to carbon dioxide were measured before surgery, and during the first 4 h of recovery in 18 adult patients who underwent elective limb surgery under fentanyl or Innovar anaesthesia. End-tidal and mixed venous PCO2 were increased significantly in the first 150 min after the last dose of drug (P less than 0.001, P less than 0.

Studies on the pharmacokinetics and pharmacodynamics of atenolol in man.

The non-stimulant cardioselective beta adrenocepter antagonist atenolol has been studied in volunteers in order to define its pharmacokinetic characteristics. Atenolol (100 and 200 mg orally) is rapidly absorbed, reductions in heart rate and systolic pressure being observed in 30 min. The effect persists for up to 8 h.