Articles: general-anesthesia.
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Implantable cardioverter defibrillator implantation is performed under general anaesthesia. This report describes awareness or recall in two of 33 patients scheduled for implantation. ⋯ In these two patients propofol flowed out of the bleeding central venous access. To minimise the possibility of awareness, we advise that continuous infusions should be administered intravenously on the contralateral side to the implantation and that neuromuscular blocking agent be given by intermittent bolus injections.
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Case Reports
Anesthetic management of a patient with obstructive sleep apnea syndrome and difficult airway access.
Patients with the obstructive sleep apnea syndrome (OSAS) are predisposed to respiratory complications under the influence of sedative and anesthetic drugs because of these drugs' alternation of respiratory control with a tendency for upper airway collapse. Additional difficulties for airway management during anesthesia may arise if fixed anatomic obstacles block the upper airway. We present a case of a patient with OSAS scheduled for general anesthesia for nasal polypectomy and correction of a deviated septum. ⋯ An individualized strategy of airway management based on published standards was developed and successfully applied. It involved fiberoptic guided intubation through a laryngeal mask airway. This case illustrates the management of patients with OSAS and additional conditions that reduce upper airway patency.
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Case Reports
Tracheal occlusion in the prone position in an intubated patient with Duchenne muscular dystrophy.
A 15-year-old boy with Duchenne muscular dystrophy developed complete airway obstruction under general anaesthesia when positioned prone for spinal surgery. Tracheobronchial compression against vertebral bodies facilitated by a shortened sternovertebral distance due to thoracic lordoscoliosis is suggested as the cause.
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Scoliosis surgery presents the anesthetist with specific clinical challenges. Since scoliosis is the most common problem for which patients of congenitally short stature present to the operating room, the preoperative evaluation of dwarfs is discussed here in the context of a patient with spondyloepiphyseal dysplasia congenita. ⋯ Consideration is given to cervical spine abnormalities, congenital absence of the odontoid process, pulmonary function abnormalities, and mucopolysaccharidosis (a syndrome which may compromise airway management). The intraoperative monitoring of somatosensory evoked potentials and their significance are also discussed.
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Randomized Controlled Trial Clinical Trial
Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial.
To compare the effect of epidural vs general anesthesia on the incidence of long-term cognitive dysfunction after total knee replacement surgery in older adults. ⋯ The type of anesthesia, general or epidural, does not affect the magnitude or pattern of postoperative cognitive dysfunction or the incidence of major cardiovascular complications in older adults undergoing elective total knee replacement. This is the largest trial of the effects of general vs regional anesthesia on cerebral function reported to date, with more than 99% power to detect a clinically significant difference on any of the neuropsychological tests.