Articles: general-anesthesia.
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Editorial Comment Comparative Study
General versus regional anesthesia for peripheral vascular surgery. Is the problem solved?
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In the postoperative period patients are at risk of excessive oxygen consumption (VO2). However, patients suffering from cardiovascular disease may be unable to increase their oxygen transport capacity sufficiently and may be especially vulnerable to tissue hypoxia as part of the reaction to intraoperative stress. During the last 10 years conflicting results concerning the benefits of a combined epidural and light general anaesthesia have been published. ⋯ In the early postoperative period (5 min) patients in group 1 showed a VO2 or 3.6 +/- 0.4 ml.kg-1.min-1. This was the same as in group 3 (3.5 +/- 0.3 ml.kg-1.min-1). In contrast, in group 2 a VO2 of 5.3 +/- 0.7 ml.kg-1.min-1
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Cortical blood flow (CoBF) was measured continuously by the laser-Doppler method to evaluate the effect of hypercapnia on cortical blood flow during ten surgical procedures in ten young patients (mean +/- SD 9.3 +/- 6.4 yr) with Moyamoya disease. The CoBF was 42.8 +/- 13.4 (ml.100 g-1.min-1) during normocapnia (PaCO2 = 39.0 +/- 2.4 mmHg), and 38.7 +/- 14.4 during hypercapnia (PaCO2 = 47.1 +/- 2.5 mmHg). ⋯ He concluded that patients with Moyamoya disease have a precarious cerebral circulation and hypercapnia may be detrimental to the cortical circulation. This suggests that normocapnia is preferable to hypercapnia in patients with Moyamoya disease during anaesthesia.
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Acta Anaesthesiol Scand · Aug 1993
Randomized Controlled Trial Clinical TrialAnaesthesia for coronary artery bypass grafting: opioid-analgesia combined with either flunitrazepam, propofol or isoflurane.
This is a prospective, open, randomized study comparing three different anaesthetic regimens with respect to haemodynamic stability (cardiac index and pressure measurements), ischaemia (ECG), and loss of awareness (midlatency auditory evoked potentials in 58 patients undergoing coronary artery surgery. Anaesthesia was based on fentanyl 0.01 mg kg-1 bw for induction and 0.8-2.0 mg h-1 in combination with nitrous oxide for maintenance before cardiopulmonary bypass and 0.2-0.6 mg h-1 without nitrous oxide during and after cardiopulmonary bypass. Eighteen patients were anaesthetised with flunitrazepam 0.01 mg kg-1 bw for induction and received thereafter 1-2 mg h-1 for maintenance (group F). ⋯ Surgery and sternotomy caused an increase in SVI and APs/SV in all groups. Differences between the groups were only found for systemic pressures, which after sternotomy were lowest in group I and before cardiopulmonary bypass were highest in group F. After termination of bypass all groups showed an increase in HR and a decrease in SVI, SVR, and LVSWI compared to the awake state, while CI remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)