Articles: general-anesthesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Profile of the effect of succinylcholine after pre-curarization with atracurium, vecuronium or pancuronium].
The depolarizing muscle relaxant succinylcholine (SCh) may cause several side effects including muscle fasciculations and postoperative myalgia. These can be attenuated or even prevented by prior administration of a non-depolarizing muscle relaxant. A study was conducted to detect any difference between clinically established approaches concerning the successful prevention of muscular side effects and the influence on the time profile of SCh action. ⋯ The prolonged duration of the SCh effect after pancuronium is probably due to the known inhibition of cholinesterase by pancuronium. The short duration of action after Atracurium and Vecuronium can be explained by the competitive antagonism at the receptor causing an increased amount of unbound SCh. The duration of the SCh effect may be influenced according to clinical needs by the choice of the non-depolarizing muscle relaxant. The significantly reduced duration of complete neuromuscular block after Atracurium or Vecuronium as precurarizing agents may be advantageous in cases where a fast recovery of spontaneous breathing is essential. If a reduction of the SCh blockade has to be avoided, Pancuronium should be selected for prior administration.
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Clinical Trial Controlled Clinical Trial
Volumetric analysis of aeration in the lungs during general anaesthesia.
Spiral computed tomography (CT) allows volumetric analysis of formation of atelectasis and aeration of the lungs during anaesthesia. We studied 26 premedicated patients undergoing elective surgery allocated to group 1 (conscious, spontaneous breathing, investigating inspiration and expiration), group 2 (general anaesthesia with mechanical ventilation, investigating inspiration and expiration) or group 3 (general anaesthesia with mechanical ventilation, investigating changes over time). Using spiral CT, the lungs were studied either before or during general anaesthesia. ⋯ The mechanism of atelectasis appeared to be both gravitational forces and a diaphragm-related force that acts regionally in caudal lung regions. Mean atelectasis formation and poorly aerated regions comprised approximately 4% of the total lung volume between the diaphragm and carina, giving a mean value of 16-20% of the normal aerated lung tissue being either collapsed or poorly aerated. The vertical ventilation distribution was more even during anaesthesia than in the awake state.
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Middle East J Anaesthesiol · Jun 1996
Comparative StudySevere neck burns and laryngeal mask airway for frequent general anesthetics.
Securing the airways in a patient suffering severe neck burns or its sequalae may present a challenge to the most experienced anesthesiologist. We investigate the utility of the Laryngeal Mask Airway (LMA) in this situation. We report on success, failure of complications of LMA insertion at the induction of general anesthesia in 23 patients of a Major Burns Unit and compare our results to our records of patients intubated endotracheally in the Unit. 14 out of 15 patients with neck burns had a LMA inserted with no difficulty or complications, while difficult endotracheal intubations in patients with neck burns were more frequent with statistical significance compared to patients with intact necks. LMA insertion seems to ignore the difficulties met with endotracheal intubation in this context.
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We studied prospectively 800 paediatric patients undergoing repair of cleft lip and palate to determine the predictors of difficult laryngoscopy. The incidence of difficult laryngoscopy (Cormack and Lehane grade III and IV) was 2.95% in patients with unilateral cleft lip, 45.76% in bilateral cleft lip and 34.61% in patients with retrognathia. Tracheal intubation was successful in 99% of patients in whom laryngoscopy was difficult. There was a significant association between age and laryngoscopic view (P < 0.01).
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J Laparoendosc Surg · Jun 1996
Clinical TrialGeneral anesthesia using the laryngeal mask airway during brief, laparoscopic inspection of the peritoneum in children.
The authors prospectively examined the cardiorespiratory changes seen with general anesthesia using the laryngeal mask with spontaneous ventilation during brief laparoscopic inspection of the peritoneum in children. Anesthesia consisted of halothane in 50% oxygen/air and a caudal epidural block. The patient was allowed to ventilate spontaneously without assistance. ⋯ The increased ETCO2 returned to baseline within 2 to 7 min (4.7 +/- 1.5 min) following completion of the laparoscopy. There was no significant change in oxygen saturation. Our initial experience suggests that general anesthesia may be provided using the laryngeal mask during brief laparoscopic inspection of the peritoneum.