Articles: general-anesthesia.
-
Comparative Study Clinical Trial Controlled Clinical Trial
Epidural morphine reduces the risk of postoperative myocardial ischaemia in patients with cardiac risk factors.
Perioperative myocardial ischaemia is a predictor of postoperative cardiac morbidity (PCM). Epidural anaesthesia and adequate perioperative analgesia have been shown to improve myocardial oxygen dynamics due to interruption of pain and sympathetic pathways. The aim of the present study was to compare the incidence of ischaemia after either general anaesthesia followed by parenteral analgesia with morphine or combined epidural/general anaesthesia followed by analgesia with epidural morphine. ⋯ Forty-two percent of ischaemic episodes were associated with a heart rate > 100 bpm, or an increase of 20% over the baseline heart rate. We conclude that epidural anaesthesia/analgesia reduces but does not eliminate the risk of myocardial ischaemia and tachyarrhythmia. We were unable to determine any associated reduction in the risk of PCM.
-
A young man underwent anaesthesia and surgery after multiple fractures. After 2 hours of anaesthesia, the patient developed hypercapnia, acidosis, hyperpyrexia and mild muscle rigidity. ⋯ Muscle tension studies with caffeine-halothane and muscle histology proved normal. The differential diagnosis of this abnormal metabolic response is briefly discussed.
-
Preterm and ex-preterm infants are at risk for life-threatening apnea after general anesthesia. The authors attempted to define the postconceptual age beyond which apnea is less likely to occur and to identify the factors that predispose to postanesthetic apnea. ⋯ Ex-preterm infants younger than 44 weeks postconceptual age are at greater risk for apnea after general anesthesia than are infants older than 44 weeks postconceptual age. Based on these results, the maximum long-run risk of postanesthetic apnea in preterm infants older than 44 weeks postconceptual age is 5% with 95% confidence.
-
Nitrous oxide diffuses into endotracheal tube cuff and then overexpand the cuff. This causes upper airway obstruction and trauma in intubated patients during general anesthesia. On the other hand, pressure of endotracheal cuff is reported to decrease in time-related fashion under artificial ventilation with oxygen and air. ⋯ Clinically sealing pressure was 11.6 +/- 1.0 mmHg and necessary volume of air was 5.5 +/- 1.8 ml. The initial pressure of the inflated cuff gradually decreased to clinical sealing pressure during 130.9 +/- 30.5 min. In conclusion, when regurgitation should be prevented at the point of the clinically sealing pressure, pressure and volume of inflated cuff by air should be re-checked at an interval of about 2 hrs in intubated patients under general anesthesia without nitrous oxide.
-
Klin Monbl Augenheilkd · Jun 1993
[Brief narcosis with propofol/ketamine for administering retrobulbar anesthesia].
Eye surgery is performed under local anesthesia in more than 90% of the cases. While injecting the local anesthetics a deep sedation is desired. During surgery however the patient should be cooperative, such as to avoid inadvertent movements. We routinely perform local anesthesia (retrobulbar injection and van Lint block) under intravenous anesthesia with propofol (Disoprivan) and ketamine (Ketalar, Ketanest). ⋯ Using propofol and ketamine while performing the local anesthesia the patients are awake but relaxed and cooperative during surgery. This method has now been used routinely in over 1000 cases. It has proved to be clinically safe and efficient. It offers the surgeon good working conditions and is well tolerated by the patients, reducing their preoperative and perioperative anxieties.