La Revue du praticien
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General anaesthesia is a reversible loss of consciousness induced and maintained with a hypnotic drug given either by venous injection and infusion, or by inhalation. A potent opioid is usually associated to inhibit the transmission of pain and thus to lessen sympathetic and endocrine reactions to nociceptive stimuli. ⋯ In addition to vital signs, the depth of anaesthesia may be monitored using automated electroencephalographic analysis and myorelaxation should always be monitored using a nerve stimulator, but pain or analgesia evaluation is only based on clinical signs of sympathetic stimulation. Because anaesthesia-related death and morbidity have decreased considerably, future improvements in outcome should concern perioperative comfort, i.e. prevention of cognitive disturbances, nausea, vomiting and pain.
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Both effects of anaesthesia and analgesia are involved in the anaesthesia risk. Most often, anaesthetic accidents appear to be related to hypoxia. Applying anaesthetic security principles allow controlling risk. ⋯ The establishment of an aimed perioperative anaesthetic strategy is the best warrant of the operative risk reduction. Assessment of individual benefit to risk ratio takes also into account the experience of the surgeon and anaesthesiologist. It implicates the patient's choice as well his general practitioner as a privileged advice.
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Local anaesthetics used for regional anaesthesia inhibit impulse depolarisation through blockade of sodium channels. Regional anaesthesia accounts for 20% of all anaesthetic procedures performed in France. Spinal anaesthesia is the most common technique used peroperatively, while epidural anaesthesia is used in labouring women and for postoperative pain control. ⋯ The risk related to the practice of regional anaesthesia compares with that of general anaesthesia and is thus very low. Main complications are epidural haematoma, cardiac arrest due to inadvertent intravascular injection of local anaesthestics, and peripheral nerve damage. Regional anaesthesia requires the same technical environment and careful monitoring as general anaesthesia.
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Patients undergoing non-cardiac surgery and who have coronary artery disease run a high risk of myocardial infarct. Diagnosis and postoperative management is presently based on assessment of cardiac troponin I. Associated with optimal postoperatory management, several approaches can limit the occurrence of postoperatory coronary complications and improve the life expectancy of surgical patients with high cardiovascular risk. They include the possibility of preoperatory myocardial revascularisation and the prophylactic, postoperatory administration of cardiovascular medications (non-steroidal anti-inflammatory drugs, beta-blockers and alpha 2 receptor agonists).