Articles: general-anesthesia.
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Comparative Study Clinical Trial
Neonatal effects of anesthesia for caesarean section.
Seventy eight parturient mothers undergoing elective caesarean section were studied with regard to the immediate neonatal outcome in those receiving general and spinal anesthesia. All mothers were of grade I anesthesia risk, were term and had singleton appropriate for gestational age fetuses. There was no difference in fetal acid base chemistry in the two groups. ⋯ Induction delivery intervals were longer in the spinal group but it was not associated with more morbidity. Uterine incision delivery intervals were very small in both groups and no meaningful conclusion could be drawn as regards effect on the newborn. A plea is made for more frequent use of spinal anesthesia considering its many postnatal advantages.
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Comparative Study
Brief wakeful response to command indicates wakefulness with suppression of memory formation during surgical anesthesia.
In a previous study of patients emerging from anesthesia following surgery, we found that a brief wakeful response to command of an eye opening or single hand squeeze or count was not associated with memory formation, while the response of four hand squeezes or counts was associated with memory. We wanted to determine the anesthetic requirements for obtaining this brief wakeful response endpoint during surgery and to determine if memory occurred at this endpoint during surgical anesthesia. ⋯ A brief wakeful response to a command of opening the eyes or squeezing the hand was not associated with increased memory formation during surgery. A brief wakeful response to command was found during surgery when patients received fentanyl 4 micrograms/kg; but it was rarely found at fentanyl dosages of 2 micrograms/kg or less.
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Blood pressure, heart rate and perspiration were and still are the only clinical signs for recognizing the depth of balanced anaesthesia in combination with muscle relaxants. Even experienced anaesthetists sometimes have difficulties in recognizing the necessary depth of anaesthesia using these parameters and in relatively rare cases the very unpleasant symptom of awareness occurs. Nowadays, processed EEG monitoring (pEEG) is used scientifically and also clinically for exact controlling of general anaesthesia. ⋯ In agreement with other investigators we found that a sufficient depth of anaesthesia could be expected when the SEF 50 ranged between 2 and 6 Hz (4.9 +/- 0.9), the SEF 90 ranged between 10 and 13.5 Hz (11.9 +/- 0.6), the SEF 95 ranged between 14 and 16 Hz (14.8 +/- 0.8) and the delta-ratio ranged between 0.7 and 1.4 (1.1 +/- 0.2). Using this anaesthetic technique and a premedication with benzodiazepine, SEF 90 SEF 95 are the best parameters for monitoring the depth of anaesthesia. In one patient blood pressure and heart rate remained constant intraoperatively, but she described intensive dreams postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1995
Clinical Trial[Continuous administration of mivacurium for short procedures. Delayed onset and recovery from neuromuscular blockade].
To assess the delays of onset and spontaneous recovery from neuromuscular block produced by mivacurium administered by continuous infusion for short procedure requiring a deep relaxation. ⋯ Mivacurium in continuous infusion provides rapidly a deep and stable neuromuscular blockade followed by a rapid spontaneous restoration of neuromuscular transmission in patients with normal pseudocholinesterases.