Articles: general-anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Removal of the laryngeal mask airway in children: anaesthetized compared with awake.
We studied 60 children, aged 12 months to 8 yr, undergoing plastic surgery under general anaesthesia supplemented by regional anaesthesia. Patients were allocated randomly to have the laryngeal mask airway removed either on awakening or while anaesthetized. ⋯ There were no differences in the incidences of laryngospasm, desaturation (< 95%) and excess salivation between the groups. Removed of the laryngeal mask airway during deep anaesthesia reduced coughing in the immediate postoperative period.
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Sleep apnoea syndrome (SAS) is a relatively common, potentially fatal, disorder. Patients with SAS exhibit repetitive, often prolonged episodes of apnoea during sleep, with serious nocturnal and diurnal physiologic derangements. Several anecdotal reports and clinical studies have documented anaesthetic-related occurrence of fatal and near-fatal respiratory complications in these patients. The purpose of this article is to outline the potential problems encountered in anaesthetic management of adult SAS patients, and to suggest a practical approach for anaesthesia both for incidental and specific procedures. ⋯ Perioperative risks attending SAS patients emphasize the importance of their detection, perioperative evaluation and planning.
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To evaluate the safety profile of ketamine when used to facilitate surgical procedures in the less controlled setting of developing world, rural hospitals. ⋯ Death and other serious complications were rare in this survey reporting > 12,000 estimated ketamine administrations in the developing world. Although the limitations of survey data are recognized, the margin of safety with ketamine appears to be high, even when administered by non-anesthesiologists in settings lacking basic mechanical monitoring. These findings have important implications for the use of ketamine outside the controlled operating room environment in developed countries.
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Cardioversion is a minor procedure requiring sedation and analgesia. However, it is often performed out-of-hours in remote sites by inexperienced anaesthetists. An understanding is required both of the pathophysiology underlying cardiac arrhythmias and of the technical side of defibrillation equipment, including electrical safety. ⋯ The anaesthetic agent chosen for patients undergoing cardioversion must provide analgesia and sedation, cause the least cardiovascular compromise possible and still enable rapid recovery. Propofol may be the closest anaesthetic agent to this ideal currently available, although careful titration of any agent chosen is also important. Cardioversion may be performed as an emergency, including in the pregnant patient, providing safe anaesthetic practice is followed.
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A new, rigid intubating fibrescope, the Upsherscope, was evaluated in clinical practice. Intubation was attempted in 200 adult patients and was successful in 191, with a median intubation time of 38 s, range 14-154 s. ⋯ Difficulties were encountered in picking up the epiglottis, in passing the tracheal tube between the vocal cords and with secretions interfering with the view. In two patients known to be difficult to intubate, the Upsherscope was successful in one patient using an awake technique and failed in the other.