Anesthesiology
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Experiences of awareness and recall during general anesthesia can be most distressing for patients. To obtain relevant information, the authors systematically interviewed patients in whom awareness during surgery had occurred, and questioned them about their experiences. ⋯ Details recalled from the period of awareness correspond with data from the literature. The anesthesiologist's role in discussing, and dealing with, traumatic experiences related to anesthesia may be of great importance. The hand-written anesthetic record is of limited value in retrospectively explaining why awareness and recall have occurred.
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It has been contended that, during cardiopulmonary bypass at 27 degrees C, pH-stat management decreases cerebral metabolic rate for oxygen (CMRO2) more than alpha-stat management. In contrast, other studies have not found CMRO2 to differ between techniques. Using each animal as its own control, the authors assessed the effect of alpha-stat versus pH-stat management of CMRO2, cerebral blood flow (CBF), and brain oxygen extraction during cardiopulmonary bypass at 27 degrees C. ⋯ During cardiopulmonary bypass at 27 degrees C, hypothermic acid-base management has no measurable effect on CMRO2. CMRO2 was neither extraction limited nor dependent on either PaCO2, CBF, or hemoglobin oxygen affinity differences between alpha-stat and pH-stat management. Cerebral blood flow responses to changing CMRO2 depend on the "starting" conditions, with alpha-stat management appearing to better preserve CBF reactivity than pH-stat management.
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Anesthesia and surgery may be associated with atrioventricular junctional or ventricular rhythm disturbances. These may be caused by alteration of automaticity of primary and subsidiary pacemakers. ⋯ It was concluded that isoflurane with E or NE acts synergistically to increase dysrhythmic potential in the arterial tissue.
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Editorial Comment Comparative Study
General versus regional anesthesia for peripheral vascular surgery. Is the problem solved?