Articles: general-anesthesia.
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J Osaka Univ Dent Sch · Dec 1995
The incidence of arrhythmias during induction of general anesthesia.
In this study, our induction methods of endotracheal anesthesia was evaluated with reference to electrocardiogram, hemodynamic status and arterial blood gas analysis on 153 patients. From the beginning of induction, electrocardiogram was recorded continuously to the completion of intubation. The blood pressure and heart rate were also measured. ⋯ As a result of careful and gentle induction techniques, the incidence of arrhythmias during intubation was very low. However, an elevation of PaCO2 was not avoidable, even in smooth and successful intubation. In conclusion, the importance of more adequate ventilation coupled with skillful intubation in a shorter period to avoid hypercapnia and arrhythmias is appreciated again in the endotracheal anesthesia for the maxillofacial surgical patients with anatomical airway problems.
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We report the anesthetic management of a patient with cardiac sarcoidosis. Cardiac sarcoidosis is characterized by a high incidence of complete atrioventricular block, right bundle branch block, and ventricular arrhythmias. Cases of sudden death during stable cardiac function have been reported. ⋯ Anesthesia was induced with midazolam and vecuronium, and the trachea was intubated. Anesthesia was maintained with nitrous oxide, sevoflurane in oxygen. Anesthetic method adapted to prevent severe complications including sudden death resulted in good condition of the patient during the perioperative period.
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The possibility that a patient during general anaesthesia is aware of the operation going on and aware of severe pain that might be remembered postoperatively must be very alarming to patients and anaesthetists alike. Furthermore, there is experimental evidence showing that conscious recall of intraoperative events is only the tip of an iceberg; it seems very probable that there is even a higher incidence of unconscious perception during general anaesthesia. Therefore, the following stages of intraoperative awareness must be distinguished: (1) conscious awareness with explicit recall and with severe pain; (2) conscious awareness with explicit recall but no complaints of pains; (3) conscious awareness without explicit recall and possible implicit recall; (4) subconscious awareness without explicit recall and possible implicit recall; (5) no awareness. ⋯ Some general anaesthetics or anaesthetic procedures, e.g. the combination of a relaxant and N2O, opioid mono-anaesthetics, or opioids combined with benzodiazepines, seem to involve a higher risk of intraoperative awareness than do volatile anaesthetics. The bases of litigation are medical malpractice, breach of contract by the anaesthesiologist or lack of informed consent from the patient. Therefore, patients who are at risk of intraoperative awareness should be given detailed information on this special risk before the operation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Assessment of recovery following day-case arthroscopy. A comparison between propofol and isoflurane-based anaesthesia.
Fifty healthy patients, aged 15-45 years, undergoing day-case arthroscopy, participated in a study to assess aspects of recovery and mood. Psychomotor tests, including the p-deletion test and the Trieger dot test, were performed pre-operatively and mood was measured using the mood adjective checklist. Anaesthesia in all patients was induced with propofol and a laryngeal mask airway was inserted immediately. ⋯ The time to discharge was similar in both groups as was the incidence of side effects. There was no difference in mood scores between the groups either at the time of discharge or at 24 h. We conclude that psychomotor recovery is somewhat quicker when isoflurane-based anaesthesia is used for day-case arthroscopy, but other factors, including time to awakening, mood and time to discharge are similar for both techniques.
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Rev Esp Anestesiol Reanim · Nov 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of changes in plasma concentrations of ACTH and beta-endorphin in cholecystectomy under general anesthesia and general plus epidural anesthesia].
To study neuroendocrine response during cholecystectomy under general anesthesia with fentanyl and under general anesthesia with nitrous oxide plus thoracic epidural block, by determining plasma levels of ACTH and beta-endorphin. ⋯ General anesthesia with fentanyl at the dose used in this study was more effective that combined anesthesia in mitigating the release of ACTH and beta-endorphin during cholecystectomy.