Anesthesia and analgesia
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Laser surgery offers several advantages to the surgeon and patient: microscopic precision, a bloodless operative field, and complete sterility. While the majority of procedures pose few problems beyond protection of the eyes of operating room personnel and patients, microlaryngeal surgery with the CO2 laser requires very careful anesthetic management. A preoperative visit to determine the degree of existing airway obstruction is mandatory in deciding the safest anesthetic technique. ⋯ We have reviewed selected aspects of the management of the patient undergoing laser surgery, outlined the principles of laser technology, and listed the many surgical procedures employing lasers. Also, recommendations on anesthetic management of microlaryngeal surgery with the CO2 laser with emphasis on currently available measures to prevent problems were reviewed in light of our own experience with this technique along with a summary of the literature on laser surgery. An understanding of the fundamental principles and applications of lasers will hopefully lead to safer patient care.
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Anesthesia and analgesia · Feb 1983
Randomized Controlled Trial Comparative Study Clinical TrialThromboembolism after total hip replacement: role of epidural and general anesthesia.
The effects of continuous epidural anesthesia and of general anesthesia on the incidence of thromboembolism following total hip replacement were studied. Sixty patients were randomly allotted to one of two groups receiving either epidural or general anesthesia. Epidural anesthesia (N = 30) consisted of 0.5% bupivacaine with epinephrine intraoperatively; for pain relief in the postoperative period (24 h), 0.25% bupivacaine with epinephrine was given every 3 h. ⋯ Possible explanations for these differences include increased circulation in the lower extremities, less tendency for intravascular clotting to occur, and more efficient fibrinolysis in association with continuous epidural anesthesia. The decrease in blood loss associated with epidural anesthesia with lower transfusion requirements also might play a role. Epidural analgesia prolonged into the postoperative period, in addition to other appropriate thromboprophylactic measures, should be of value in patients undergoing operations associated with a high risk of thromboembolic complications.
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Anesthesia and analgesia · Feb 1983
Precision and accuracy of intraoperative temperature monitoring.
Using tympanic membrane (TM) temperature as a standard for core temperature, we quantitated the accuracy and precision of seven other temperature monitoring sites during anesthesia, namely, the nasopharynx, esophagus, rectum, bladder, axilla, forehead, and great toe. Accuracy was quantitated as the difference between TM temperature and the temperature at each of the other sites; precision was quantitated as the correlation between TM temperature and the temperature at each of the other sites. ⋯ Precision of measurements made using the nasopharynx, esophagus, and bladder is greater than the precision at the axilla, forehead, and rectum, and much higher than the precision at the great toe. Measurements of body temperature using the nasopharynx, esophagus, and bladder are recommended for intraoperative use as providing the best combination of accuracy and precision.