Articles: general-anesthesia.
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Ugeskrift for laeger · Apr 1993
Comparative Study[Complications of spinal anesthesia compared to general anesthesia. A prospective study of 408 consecutive orthopedic patients].
In this prospective study the preoperative risk classification and pulmonary status was compared to postoperative mortality and morbidity, following either spinal or general anaesthesia. We studied 408 consecutive orthopaedic patients. Comparing the anaesthetic methods we found no differences in mortality or in frequency of cardiac complications, while the non-cardiac complications were seen more frequently in patients who had undergone spinal anaesthesia (p < 0.05). Patients from the lower risk groups with a preoperative abnormal pulmonary status had a higher frequency of postoperative pulmonary complications following spinal anaesthesia than following general anaesthesia (p = 0.015). ⋯ 1) We find no difference in postoperative mortality depending on the anaesthetic method chosen, 2) the predictive value of the Boston Cardiac Risk index is identical for the two anaesthetic methods, and 3) the anaesthetic method of choice for the pulmonary disabled patient has not yet been established.
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Randomized Controlled Trial Clinical Trial
Perioperative gastric aspiration increases postoperative nausea and vomiting in outpatients.
The efficacy of aspiration of gastric contents to reduce postoperative nausea and vomiting was investigated in a controlled randomized, double-blind study of 265 outpatients. Patients in the treated group had their stomachs aspirated with an orogastric tube. In the control group no tube was inserted. ⋯ It was also comparable in the recovery room and the day surgery unit. However, treated patients had a higher incidence of both nausea (26.5% vs 12.0%, P < 0.005) and vomiting (16.7% vs 6.8%, P < 0.02) after their discharge from the day surgery unit. We conclude that aspiration of gastric contents with an orogastric tube does not decrease postoperative nausea and vomiting in outpatients and may increase it after discharge of the patient.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1993
Review[Indications for the use of human albumin in anesthesia and intensive care medicine].
The plasmatic albumin concentration (3.5-4.5 g/dl) represents about 60% of the total plasma protein. Only 25-40% of whole albumin belongs to the intravascular pool, the majority is distributed in the interstitial space especially of the skin. Main physiological effects of plasmatic albumin are the control of the plasmatic volume by preservation of the colloid oncotic pressure (COP) and the plasmatic transport including the binding of drugs. ⋯ For prevention of interstitial pulmonary oedema, a COP of 15-20 mmHg should be achieved. Up to now, no clinical study verified a positive effect of albumin substitution regarding outcome or incidence of complications in intensive-care patients. Thus, an albumin therapy to maintain a COP of 15-20 mmHg in intensive-care patients is only recommended if a capillary leak is unlikely and the dose limits of synthetic colloids are attained.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta Anaesthesiol Scand · Apr 1993
Randomized Controlled Trial Clinical TrialEffect of dihydroergotamine on leg blood flow during combined epidural and general anaesthesia and postoperative deep vein thrombosis after cholecystectomy.
The effects of dihydroergotamine (DHE) on the circulation of the leg during combined epidural and general anaesthesia were studied to determine if DHE would enhance leg blood flow and prevent postoperative deep vein thrombosis in a double-blind trial of 40 elderly female patients subjected to cholecystectomy. Central and big toe temperature, arterial blood pressure, heart rate, calf volume and arterial inflow of the leg by electrical impedance plethysmography and the venous outflow by Doppler method were measured. DHE 0.5 mg subcutaneously reduced the volume of the leg, i.e. increased the electrical impedance, probably due to venous vasoconstriction. ⋯ Intraoperative characteristics in patients with postoperative DVT were tachycardia (P < 0.001), enhanced need for etilefrine (P < 0.01) and a more rapid increase in big toe temperature (P < 0.05) after induction of epidural analgesia, compared with patients without DVT. Femoral vein flow velocity remained at the preinduction level, whereas pulsatile arterial inflow slightly increased. Together with a low basal impendance of the leg, the changes were indicative of a more intense vasodilatation, probably leading to stagnant flow and development of postoperative deep vein thrombosis.
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Laparoscopic surgery minimises postoperative morbidity. Patient benefits include reduction in postoperative pain, better cosmetic result and quicker return to normal activities. Hospital stay is shortened resulting in a reduction in overall medical cost. ⋯ An appraisal of the potential problems is essential for optimal anaesthetic care of patients undergoing laparoscopic surgery. Appropriate anaesthetic techniques and monitoring facilitate surgery and allow early detection and reduction of complications. The need for rapid recovery and short hospital stay impose additional demands on the anaesthetist for skillful practice.