Articles: general-anesthesia.
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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.
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Multichannel laser Doppler flowmeters allow continuous, simultaneous measurement of perfusion in several organs. We measured microcirculatory blood flow in the kidney, liver, skin and skeletal muscle in 10 anaesthetized rats subjected to abdominal surgery and graded haemorrhage (withdrawal of 5% total blood volume every 10 min). Mean arterial blood pressure, heart rate and haemoglobin concentrations were also measured. ⋯ We conclude that laser Doppler flowmetry is useful for continuous measurement of microcirculatory blood flow in several organs simultaneously during haemorrhagic hypovolaemia. It showed that microcirculatory blood flow in skeletal muscle is particularly sensitive to lesser degrees of blood loss during anaesthesia. Hypovolaemia-induced slow wave flowmotion occurred only in skeletal muscle, which may be linked to fluid mobilization during haemorrhage.
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Case Reports
Peripartum cardiomyopathy presenting as a cardiac arrest at induction of anaesthesia for emergency caesarean section.
Peripartum cardiomyopathy is defined as the onset of acute heart failure without demonstrable cause in the last trimester of pregnancy or within the first 6 months after delivery. It occurs in about 1 in 4000 deliveries and is often unrecognized as symptoms of normal pregnancy commonly mimic those of mild heart failure. We describe a previously asymptomatic patient who presented with a cardiac arrest at induction of general anaesthesia for emergency Caesarean section and subsequently developed acute heart failure. This case is unique both in its mode of presentation and the total absence of antecedent symptoms or signs of cardiac disease.