Articles: general-anesthesia.
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The Journal of urology · Feb 1994
Case ReportsDorsal nerve block for management of intraoperative penile erection.
Intraoperative penile erection during general anesthesia can delay or prevent the completion of cystoscopic or penile surgical procedures. The dorsal penile nerve block is offered as a treatment for intraoperative erection. Advantages of this technique include less potential for cardiovascular complications and improved postoperative analgesia.
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A cuffed nasopharyngeal airway was used in five cases of difficult intubation, initially to maintain anaesthesia, and subsequently to act as a landmark for the passage of a fibreoptic laryngoscope loaded with a tracheal tube. In all cases, airway patency was well preserved with the device and there were no significant problems with its use. The notion of a 'dedicated airway' for difficult intubation cases is developed. A trouble-free airway will permit time to consider solutions for difficult cases and time for the novice to learn fibreoptic laryngoscopy technique.
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Randomized Controlled Trial Clinical Trial
Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia.
The authors tested the hypotheses that: (1) the vasoconstriction threshold during combined epidural/general anesthesia is less than that during general anesthesia alone; and (2) after vasoconstriction, core cooling rates during combined epidural/general anesthesia are greater than those during general anesthesia alone. Vasoconstriction thresholds and heat balance were evaluated under controlled circumstances in volunteers, whereas the clinical importance of intraoperative thermoregulatory vasoconstriction was evaluated in patients. ⋯ These data indicate that epidural anesthesia reduces the vasoconstriction threshold during general anesthesia. Furthermore, the markedly reduced rate of core cooling during general anesthesia alone illustrates the importance of leg vasoconstriction in maintaining core temperature.
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Anesthesia and analgesia · Feb 1994
Randomized Controlled Trial Clinical TrialDetermination of the hemodynamics and histamine release of rocuronium (Org 9426) when administered in increased doses under N2O/O2-sufentanil anesthesia.
The cardiovascular effects, histamine release potential, and pharmacodynamics of rocuronium were determined in adult patients randomized to receive rapid (5 s) intravenous (i.v.) bolus doses of 600, 900, or 1200 micrograms/kg (2.0, 3.0, and 4.0 times the ED95) with maintenance doses of 150 micrograms/kg. There were no statistically significant hemodynamic effects (heart rate, blood pressure, mean arterial pressure [MAP] or electrocardiogram [ECG]) after administration of rocuronium. ⋯ The mean +/- SD clinical durations of 600-, 900-, and 1200-micrograms/kg intubating doses of rocuronium under N2O/O2-sufentanil anesthesia were 45 +/- 20 min, 66 +/- 16 min, and 85 +/- 22 min, respectively. We conclude that rocuronium can be administered safely over a wide range of doses (2-4 x ED95), with minimum hemodynamic effects or histamine release.
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Randomized Controlled Trial Clinical Trial
Memory for auditory material presented during anaesthesia.
We have assessed postoperative memory for lists of 10 neutral words, presented by tape recording, in patients anaesthetized by a standardized technique comprising thiopentone 5 mg kg-1, midazolam 0.07 mg kg-1, fentanyl 3 micrograms kg-1 and 70% nitrous oxide in oxygen, using both free recall and a test in which the subject was asked to indicate the presented words from a larger list. Twenty-four patients were exposed to one of four tape-recorded lists of words and 24 were presented with a blank tape. There was no instance of free recall of presented words. Analysis of the responses in the implicit memory test revealed no difference between the performance of the patients who had been exposed to a word list and those who had not.