Articles: general-anesthesia.
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Forty-two patients underwent cerebral aneurysm clipping at our institution in 1991, 35 with a ruptured aneurysm and 7 with an unruptured aneurysm. Preoperatively, 22 patients with a ruptured aneurysm were graded I or II according to the World Federation of Neurosurgical Societies and 21 underwent an operation on the first day. All underwent a standard cerebral protective general anesthesia, combining propofol with fentanyl, arterial normotension (mild hypertension with volume loading and/or dopamine during temporary clipping and once the aneurysm was secured), normocarbia or slight hypocarbia, brain relaxation with lumbar drainage, mannitol and propofol, and electroencephalogram burst suppression when temporary clipping (> or = 2 min) was required. ⋯ In 21 patients, temporary clipping was required for a mean duration of 8.8 +/- 1.3 minutes (range, 2-29); none of these patients deteriorated as compared with their preoperative neurological state. Twenty-four of the 42 patients (57%) had a Glasgow Coma Outcome Scale (GOS) score of 1, 7 patients had a GOS score of 2, 8 had a score of 3, and 3 had a score of 5. Thirty-two patients were extubated in the operating room with a mean GOS Score of 13.2 +/- 0.5, and 10 were extubated later in the intensive care unit.(ABSTRACT TRUNCATED AT 250 WORDS)
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The neuromuscular effects of intravenous rocuronium bromide, 0.6 mg.kg-1 or 0.9 mg.kg-1, were studied in four groups of 10 patients during anaesthesia with or without halothane (0.5-0.75% inspired concentration). Neuromuscular block was monitored using mechanomyography and train-of-four stimulation. The mean times to onset of complete neuromuscular block were 58 and 59 s using the 0.6 mg.kg-1 dose in patients anaesthetised with fentanyl and halothane respectively. ⋯ All the parameters were significantly different between the 0.6 mg.kg-1 and 0.9 mg.kg-1 doses. Halothane in the concentrations used did not influence the neuromuscular effects. It is concluded that rocuronium is a rapidly acting non-depolarising muscle relaxant with a duration of action similar to that of vecuronium and may be a useful alternative to suxamethonium for rapid tracheal intubation.
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In 1988, a confidential postal questionnaire was prepared in order to assess the techniques used routinely in France for prophylaxis of aspiration of gastric contents in obstetrics. Of the 297 anaesthetists who responded, 81% (237) worked almost always and 19% worked occasionally in obstetric anaesthesia. Although obstetric anaesthesia is considered to carry a particular risk of aspiration of gastric contents (88.5% of responders), only 23% used in every case a complete set of prophylactic measures. ⋯ Among the users of cricoid pressure, 52% were able to describe precisely the technique. Tracheal intubation is considered mandatory when general anaesthesia is performed for Caesarean section but not for uterine revision or instrumental manoeuvre. 74% of obstetric anaesthetists believe that regional anaesthesia is the best anaesthetic technique for Caesarean section. This survey has shown both positive results indicating that continuing medical education of French anaesthetists follows at least in part the 'state of the art' and insufficiencies indicating that training continues to be necessary to reduce the mortality related to aspiration of gastric contents.
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Pulmonary aspiration of gastric contents during the perioperative period may be associated with postoperative mortality or pulmonary morbidity. Recent determination of the incidence of perioperative pulmonary aspiration and evaluation of factors related to clinical outcomes is lacking. ⋯ This study suggests that patients with clinically apparent aspiration who do not develop symptoms within 2 h are unlikely to have respiratory sequelae.
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Review Case Reports
[Definitive transient monocular blindness caused by ocular compression during general anesthesia].
We present a case of irreversible monocular blindness caused by obstruction of the central retinal artery detected in a young patient without any previous history, when waking up from a surgical procedure performed under general anesthesia. Clinical and complementary investigations were not conclusive. ⋯ The fact that the patient was simultaneously submitted to a controlled low blood pressure may have worsened the effects of the compression. Reviewing the medical literature on the subject reveals that, although rare, such accidents do occur; they must be prevented by a constant surveillance when performing surgical procedures.