Articles: general-anesthesia.
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Nowadays approximately 20% of all patients operated are older than 60 years of age. So it seems to be interesting to investigate the effect on the increase of systemic disease of these patients, to estimate a proper anaesthesiological management. ⋯ Therefore preoperatively registration and therapy of these risks are necessary, however diagnostic evaluation cannot be standardized. There is no typical anaesthesia for the elderly.
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Oxygen saturation and cardiovascular changes during fibreoptic intubation under general anaesthesia.
Sixty patients who required fibreoptic nasotracheal intubation were studied. Arterial oxygen saturation, arterial blood pressure and heart rate were monitored continuously during fibreoptic intubation under deep halothane anaesthesia. ⋯ Almost one third of the patients (18 out of 60) suffered a decrease in arterial oxygen saturation below 90% during the intubation sequence and in five patients the saturation fell below 80%. The episodes of desaturation were not related to the induction-intubation time or to the grade of laryngeal visibility at direct laryngoscopy.
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Aneurysmal rupture represents the most common cause of subarachnoid hemorrhage. Approximately two-thirds of persons who experience a subarachnoid hemorrhage will die or become disabled. ⋯ The anesthetic management of these patients is reviewed, emphasizing principles relating to the facilitation of surgery--by optimizing operative conditions and minimizing the risks of intraoperative aneurysmal rupture or the aggravation of neurologic deficits--and to the provision of a smooth, stable recovery. Despite the disappointing overall prognosis following subarachnoid hemorrhage, adherence to these principles can optimize the outcome for those patients who reach the operating room.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative evaluation of the neuromuscular and cardiovascular effects of pipecuronium, pancuronium, atracurium, and vecuronium under isoflurane anesthesia.
The neuromuscular and cardiovascular effects of intubating doses of pipecuronium 80 micrograms/kg, pancuronium 100 micrograms/kg, atracurium 500 micrograms/kg, and vecuronium 100 micrograms/kg were compared in 62 patients under isoflurane (end-tidal concentration = 0.5-1%) anesthesia. Pipecuronium, pancuronium, and vecuronium had no significant effect on systolic or diastolic blood pressure. In one patient the administration of atracurium resulted in significant hypotension. ⋯ The neuromuscular-blocking effect of pipecuronium and pancuronium appears to be twice as long as that of vecuronium and atracurium. Administration of neostigmine resulted in significantly faster recovery of muscle function in patients receiving vecuronium or atracurium. Although pipecuronium's neuromuscular-blocking effect is similar to that of pancuronium, its lack of cardiovascular effects more closely resembles that of vecuronium.
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Thermoregulatory responses in infants and children are now fairly well understood. The phenomenon of heat loss in children during surgery is widely acknowledged. Hypothermia is most likely to occur during long surgical procedures in an air-conditioned operating room, particularly when respiration is controlled. ⋯ Perioperative hypothermia results from decreased metabolic heat production, increased environmental heat loss, redistribution of heat within the body, and anesthesia-induced inhibition of thermoregulation. Radiation and convection from the skin surface combine with evaporation from tissues inside surgical incisions to decrease mean body temperature. Perioperative hypothermia can be limited by prewarming the skin surface before induction of anesthesia, warming the operating room, humidifying the airway, and warming intravenous fluids.