Articles: general-anesthesia.
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As a result of more offensive therapeutic measures and the given abilities of modern medicine and the increasing number of geriatric patients who are characterized by multimorbidity, more perioperative complications, in particular those of cardiac origin, can be expected. As in any other medical discipline, the safety of anaesthesiological care of the patient very much depends on the individual professional qualification and competence of the physician. For the field of anaesthesiology it can be concluded that it is necessary to tackle the specific problems of this risk group in order to reduce the rate of complications to a minimum. ⋯ Three main symptoms--increasing oxygen uptake (as a product of pain or shivering), hypoventilation and hypoxaemia--should be avoided in the postoperative period. Therefore, respiratory insufficiency should be diagnosed without fail by respiratory monitoring. If required, artificial ventilation must be continued, with particular attention being given to circulatory effects during artificial ventilation and weaning from the ventilator.
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Animal studies show that airway receptors responsible for eliciting respiratory protective reflexes are not uniformly distributed in the airways. Based on this information, it is possible that the protective reflex responses to airway irritation in humans may vary, depending on the site of stimulation. The purpose of this study is to examine whether the protective reflex responses evoked from the larynx are different from those evoked from the lower airways and to see how change in depth of anesthesia modifies the protective reflex responses evoked from individual sites. ⋯ The respiratory reflex responses evoked by injection of water vary, depending on the site of stimulation. The incidence of various reflex responses was not affected by the changing depth of anesthesia. The sensitivity to airway irritation seems to be greater at the larynx and trachea than at the more peripheral airways.
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Mivacurium is a potent, short-acting, nondepolarizing relaxant of the benzylisoquinoline series. In adults endotracheal intubation can be performed after a 2 x ED95 dose of 0.15-0.2 mg/kg within 2-2.5 minutes. In infants onset time and clinical duration of mivacurium are significantly shorter than in adults. ⋯ The properties of mivacurium described above are related to patients with normal pseudocholinesterase activity. Particularly patients with atypical pseudocholinesterase show a marked increase in clinical duration. Side-effects due to significant histamine release with flush, tachycardia and hypotension are seldom observed if mivacurium is injected slowly over a period of more than 30 seconds and bolus injections of more than 2 x ED95 or 3 x ED95 are avoided.
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The authors prospectively evaluated the use of a continuous caudal epidural infusion of chloroprocaine as an adjunct to general anaesthesia during intra-abdominal surgery in neonates. ⋯ Caudal anaesthesia with a continuous infusion of chloroprocaine can be used as an adjunct to general anaesthesia during abdominal surgery in neonates. Our initial experience suggests that the combined technique may eliminate the need for parenteral opioids and limit the intraoperative requirements for inhalational anaesthetic agents.
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Anesthesia progress · Jan 1996
Case ReportsAnesthetic considerations of two sisters with Beckwith-Wiedemann syndrome.
Anesthetic considerations of 21-mo-old and 4-yr-old sisters with Beckwith-Wiedemann syndrome during surgical repair of cleft palate and reduction of macroglossia are presented and discussed. This syndrome is characterized by exomphalos, macroglossia, gigantism, hypoglycemia in infancy, and many other clinical features. This syndrome is also known as exomphalos, macroglossia, and gigantism (EMG) syndrome. ⋯ Careful intraoperative plasma glucose monitoring is particularly important to prevent the neurologic sequelae of unrecognized hypoglycemia. It is expected that airway management would be complicated by the macroglossia, which might cause difficult bag/mask ventilation and endotracheal intubation following the induction of anesthesia and muscle paralysis, so preparations for airway difficulty (e.g., awake vocal cord inspection) should be considered before induction. A nasopharyngeal airway is useful in relieving postoperative airway obstruction.