Articles: general-anesthesia.
-
Regional anesthesia · Sep 1995
Case ReportsThe pregnant patient with an intracranial arteriovenous malformation. Cesarean or vaginal delivery using regional or general anesthesia?
A parturient with large intracranial arteriovenous malformation presented for elective cesarean delivery. ⋯ In this case report the choice of obstetric management (cesarean versus vaginal delivery) of a full-term parturient with an intracranial arteriovenous malformation is discussed, and the rationale for the preference of epidural anesthesia for the cesarean delivery is presented.
-
Anesthesia and analgesia · Aug 1995
Large tidal volume ventilation does not improve oxygenation in morbidly obese patients during anesthesia.
Eight morbidly obese patients (body mass index [BMI] = 46) were studied during general anesthesia and controlled mechanical ventilation. To evaluate the effect of large tidal volume ventilation on oxygenation and ventilation, the baseline 13 mL/kg tidal volume (VT) (calculated by the ideal body weight) was increased in 3 mL/kg volume increments to 22 mL/kg, while ventilatory rate (RR) and inspiratory time (TI) were kept constant. Each volume increment was maintained for 15 min. ⋯ Peak inspiratory airway pressure (Ppeak), end-inspiratory airway pressure (Pplateau), and compliance of the respiratory system (CRS) were recorded using the Capnomac Ultima (Datex, Helsinki, Finland) on-line respiratory monitor. Increasing tidal volumes to 22 mL/kg increased the recorded Ppeak (26.3 +/- 4.1 vs 37.9 +/- 3.2 cm H2O, P < 0.008), Pplateau (21.5 +/- 3.6 vs 27.7 +/- 4.3 cm H2O, P < 0.01), and CRS (39.8 +/- 7.7 vs 48.5 +/- 8.3 mL/cm H2O) significantly without improving arterial oxygen tension and resulted in severe hypocapnia. Since changes in arterial oxygenation were small and not statistically significant, mechanical ventilation of morbidly obese patients with large VTS seems to offer no advantage to smaller (13 mL/kg ideal body weight) VTS.