Articles: general-anesthesia.
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Comparative Study
Thoracic epidural anesthesia improves outcome after breast surgery.
The authors' objective was to compare the outcomes, including the incidence of nausea and vomiting and the time until discharge to home, of patients undergoing general anesthesia and thoracic epidural anesthesia for oncologic breast procedures. ⋯ Thoracic epidural anesthesia is a safe technique not associated with neurologic or respiratory complications. The use of thoracic epidural anesthesia for breast surgery could improve patients recovery and reduce the cost of these procedures.
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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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Can learning occur during general anaesthesia? This paper reviews the studies which have addressed this issue and finds some evidence of implicit memory for intra-operative events, even with clinically adequate anaesthesia. This has implications both for clinical practice and for psychological theories of learning and awareness. ⋯ Methodological improvements are discussed, in particular the need for a reliable means of monitoring awareness during anaesthesia. These improvements would enable researchers to determine the conditions under which learning occurs and would provide information about the role of consciousness in learning.
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We aimed to describe the frequency of atelectasis occurring during anaesthesia, to describe the size and pattern of the atelectasis, and to standardise the method of identifying the atelectasis and calculate its area. ⋯ On the basis of the present findings, we defined atelectasis as pulmonary dependent densities with attenuation values of -100 to +100 HU.