Articles: general-anesthesia.
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The accuracy of a computer-controlled infusion of midazolam, based on previously published pharmacokinetic parameters, was tested prospectively in 12 adult female patients undergoing general anaesthesia. Anaesthesia consisted of an initial bolus followed by an exponentially decreasing infusion of midazolam given according to body weight, fentanyl, nitrous oxide and vecuronium. Venous blood samples were taken at 15 min-intervals throughout the procedures and for 1-2 h postoperatively. ⋯ Retrospective fitting of an alternative set of published parameters for midazolam resulted in significant deterioration of the model. The precision was similar to that found in past studies of intravenous anaesthetic agents. Further improvement in the accuracy of midazolam infusion awaits improved understanding of the causes of pharmacokinetic variability.
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Vestn. Khir. Im. I. I. Grek. · Mar 1993
[Epidural analgesia with clofelin as a component of general anesthesia].
A clinical experience with using peridural analgesia with Clophelin in the composition of general anesthesia in 35 patients operated upon because of surgical, gynecological and urological diseases is presented. Clinical application of Clophelin in anesthesiological maintenance was preceded by an experimental study in rabbits. Control of adequacy of the anesthesia was performed by parameters of central hemodynamics and the level of vasopressin in blood plasma at stages of the research. The adequate level of defense of the patient from the operative stress was determined for using this combined method of general anesthesia.
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Anesthesia and analgesia · Mar 1993
Effect of phenylephrine bolus administration on left ventricular function during high thoracic and lumbar epidural anesthesia combined with general anesthesia.
The effect of phenylephrine (PHE) boluses on left ventricular (LV) function was examined in patients without cardiovascular disease who developed arterial hypotension during high thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) (group 1) or lumbar epidural anesthesia (LEA) combined with GA (group 2). LV function was assessed by transesophageal echocardiography (TEE) before and after central venous injection of 1 microgram/kg PHE. Fractional diameter shortening (FDS), end-systolic wall stress (ESWS), and rate-corrected velocity of circumferential fiber shortening (mVcfc) were determined. ⋯ FDS was reduced from 38% to 25% (mean, P < 0.01) in group 1 and remained unchanged in group 2. ESWS increased from 70 to 143 x 10(3) dyne.cm-2 (P < 0.01) and from 57 to 86 x 10(3) dyne.cm-2 (P < 0.05), in groups 1 and 2, respectively. mVcfc was significantly reduced from 1.11 to 0.80 circ/s (P < 0.05) in group 1 and was not altered in group 2. The authors conclude that PHE given as an intravenous bolus to patients under high TEA plus general anesthesia causes a transient impairment of LV function.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol, isoflurane and neuroleptanesthesia. Ophthalmic surgery in geriatric patients].
Ophthalmic surgeons require anaesthesia to ensure that the patient is completely relaxed for microsurgical operations and that the intraocular pressure is reduced. These conditions must be maintained throughout the operation. In addition to these requirements, the anaesthetist mostly deals with elderly patients with multiple diseases. ⋯ Therefore, it seems on the whole that there are benefits from propofol-fentanyl anaesthesia because of the fact that in comparison with the rather techniques, elderly patients become alert again faster. However, sufficient postoperative pain therapy is necessary to free the patients of pain to the same degree as with neuroleptanaesthesia. In most cases peripherally acting analgesic substances with no interference with vigilance are sufficient.
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J Burn Care Rehabil · Mar 1993
Safety and efficacy of debridement under anesthesia in patients with burns.
Burn wound debridements requiring blunt or sharp manipulations are extremely painful even when large nonanesthetic doses of morphine are used. In this study we describe the use of debridement while the patient is under anesthesia (DUA) when manipulation of the wound is required. Seventy-one debridements were performed on 46 patients. ⋯ Patients were completely anesthetized during the procedure. Therefore, they were free of pain and were amnestic for the experience. We conclude that DUA is a safe, efficacious procedure that permits full relief from the pain usually experienced during a manipulative burn wound debridement.