Articles: general-anesthesia.
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Several methods have been developed to quantify central anaesthetic effects and monitor awareness during general anaesthesia. The most important of these are the PRST score, calculated from changes in blood pressure, heart rate, sweating, and tear production, the isolated forearm technique, where the patient is allowed to move during surgery, the processed electroencephalogram (EEG) and the derived parameters median frequency (MF) and spectral-edge frequency (SEF), and mid-latency auditory evoked potentials (MLAEP). In clinical practice, the application of individual doses of anaesthetics is generally guided by autonomic vegetative clinical signs such as changes in blood pressure, heart rate, sweating, and tear production, quantified as the PRST score. ⋯ MLAEP are suppressed in a dose-dependent fashion by many general anaesthetics and correlate with wakefulness, awareness, and explicit and implicit memory during anaesthesia and seem to be a promising method of monitoring awareness during anaesthesia. Nevertheless, future studies will have to determine threshold values for the different MLAEP parameters for intraoperative awareness and explicit and implicit recall of intraoperatively presented information for the different commonly used anaesthetics. Only then will it be possible to determine the usefulness of the method in clinical practice.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cost aspects in anesthesia. Propofol versus isoflurane anesthesia].
Cost control is no longer an option, but a necessity. Propofol anaesthesia is expensive, however, the true differences in comparison to volatile anaesthetics (isoflurane) are not known. ⋯ A climate of cost-consciousness and cost-containment prevails at the present time. The costs of propofol and 'standard' isoflurane anaesthesia were without differences; however, isoflurane used in a low-flow system had the lowest cost in this study. Doubts are justified, however, as to whether the choice of anaesthetic agents may considerably lower the costs of an anaesthesia department.
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Case Reports
Anesthetic management of children with recurrent, viral laryngeal papillomatosis: a case report.
The authors report the case of a 4-year-old boy who required anesthetic care during laser excision of respiratory papillomatosis. The perioperative issues surrounding this disease process are discussed including anesthetic induction in the patient with a compromised airway, maintenance anesthetic techniques, methods used for ventilation during laser surgery of the upper airway, and infectious disease risks to the operating room personnel. In addition, the psychological and emotional impacts of recurrent surgical procedures during childhood are addressed.
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To demonstrate the feasibility of transcranial high-frequency electrical stimulation with the patient under general anesthesia with propofol and alfentanil. This method may be a useful tool for intraoperative monitoring of the motor pathways during cerebral and spinal operations. ⋯ Transcranial high-frequency repetitive electrical stimulation seems to be a new method for monitoring the motor tract. With this method, it is possible to monitor the motor function without interfering with the surgical team or with the surgical treatment of infratentorial and spinal lesions. Monitoring of relaxation is necessary to compare the amplitude of MEPs.