Articles: general-anesthesia.
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Pediatric neurology · Oct 1996
Review Case ReportsRhabdomyolysis and anesthesia: a report of two cases and review of the literature.
Rhabdomyolysis occurred in two apparently healthy boys aged 9.5 and 5.5 years after general anesthesia with suxamethonium. Mild hyperkalemia and renal failure were observed in the first patient, who was subsequently diagnosed with Becker dystrophy. In the second patient, the clinical presentation was not classic for malignant hyperthermia and a muscle biopsy failed to disclose any pathological finding. ⋯ Forty-nine (74%) cases were caused by an underlying, mostly unrecognized congenital muscle disease, and 14 (21%) cases were caused by malignant hyperthermia susceptibility. Hyperkalemia (23 patients), cardiac arrhythmias (38 patients), renal failure (4 patients), and death (11 patients) were the most serious complications of anesthesia-associated rhabdomyolysis. The neuromuscular blocking agent suxamethonium had been used in at least 43 of the patients reported in the literature.
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Regional ventilation and perfusion were studied in 10 anesthetized paralyzed supine patients by single-photon emission computerized tomography. Atelectasis was estimated from two transaxial computerized tomography scans. The ventilation-perfusion (V/Q) distribution was also evaluated by multiple inert gas elimination. ⋯ Little perfusion was seen in the most ventral parts (zone 1) of caudal (diaphragmatic) lung regions. In summary, shunt during anesthesia is due to atelectasis in dependent lung regions. The V/Q distributions differ from those shown earlier in awake subjects.
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Case Reports
[Post dural puncture headache (PDPH) which occurred after the removal of an epidural catheter].
A 57-year-old man received gastrectomy under general anesthesia combined with epidural anesthesia. He showed no signs of dural puncture and catheter migration into the subarachnoid space. Cardiovascular status was stable with epidural injection of lidocaine, morphine during the operation. ⋯ PDPH persisted over a period of 30 days and was treated with an epidural blood patch and stellate ganglion blocks since the other conservative therapy had been ineffective. We consider that administration of continuous epidural opioids for postoperative analgesia helped to prevent PDPH until the 7th postoperative day. We also conclude that prolonged PDPH after using a thick needle like a Touhy needle should be treated by an epidural blood patch.
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To examine the physiologic and pharmacokinetic effects of a technique of total intravenous anesthesia in ponies. ⋯ Ketamine-climazolan infusion appeared suitable for maintenance of anesthesia in ponies, although recovery was not ideal in 2 of 6 ponies.
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The course of surgical treatment of 124 patients aged over 70 years was subjected to an assessment. On the basis of the ASA classification, 88% of all surgically treated patients fell into group III-IV of risk. ⋯ Heart rhythm disturbances were not observed in patients under conduction anaesthesia. No intraoperative deaths were noted.