Articles: general-anesthesia.
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Two commercially available complete anesthetic simulators were studied in the United States. Although there are some differences between the two systems, each consists of an adult manikin allowing some direct anesthetic interventions, a system of producing physiologic signals to any commercial monitoring system, and the ability to interface with an anesthetic machine and ventilator. In addition, both simulators model the responses to a variety of drugs used by anesthetists. ⋯ Now available are combined systems using manikins controlled by computer, with interfaces to anesthetic machines, ventilators, and monitoring equipment. Two systems are commercially available in the United States. In this report, we briefly describe their technical specifications and how we saw them being used.
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Ann Fr Anesth Reanim · Jan 1996
Multicenter Study[Anesthesia and intensive care of subarachnoid hemorrhage. A survey on practice in 32 centres].
To assess the current practices in anaesthesia and intensive care in patients experiencing subarachnoid haemorrhage (SAH). ⋯ Twenty-nine French and three non French centers answered the questionnaire. In 14 centers, more than 60 SAH had been treated in the previous year. Angiography was performed under sedation with a benzodiazepine associated with an opioid (54%). Criteria for choosing an endovascular approach were the site of the aneurysm (81%), its neck size (42%) and the underlying disease (42%). Anaesthesia was induced with either propofol (60%) or thiopentone (40%) associated with an opioid and a muscle relaxant. It was maintained with either isoflurane (59%) or propofol (41%). Nitrous oxide was often associated (62%). During anaesthesia, nimodipine (84%), mannitol (69%), anticonvulsants (47%), dopamine (31%) and lidocaine (9%) were also administered. Postoperatively, nimodipine was administered for prophylaxis of vasospasm (97%) and transcranial Doppler was employed to diagnose vasospasm (50%). Other techniques of care included hypervolaemia (89%), controlled arterial hypertension (36%) and haemodilution (36%).
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To analyze the relationship between the development of postoperative delirium and a change of the patient's room, 1,006 cases of patients who had undergone surgery with general anesthesia were reviewed. Postoperative delirium developed in 84 (8.3%) cases. On the basis of symptomatic features, postoperative delirium was divided into four types: (1) excitement type, (2) excitement-hallucination type, (3) hallucination type, and (4) disorientation type. ⋯ Of 29 hallucination types, 22 developed after a room change while 20 of these 22 cases were transferred to a single room before POD 2. A quiet, dark, and isolated environment in a single room is suggest to contribute to the development of hallucinations. The development of postoperative delirium with hallucinations alone should thus be taken into consideration whenever a room change is decided.