Articles: general-anesthesia.
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Surgery on the shoulder often causes severe pain and, therefore, requires high doses of opiates. As postoperative pain is frequently treated inadequately, it is desirable to seek alternatives for providing effective analgesia. In a prospective study we examined the efficacy of balanced anesthesia consisting of general anesthesia combined with interscalene brachial plexus blockade for intra- and postoperative analgesia for operations on the shoulder. ⋯ CONCLUSION. The combination of ISB and GA allows a reduction in intraoperative doses of opiates and facilitates postoperative pain management. Because of the low incidence of side effects, the lack of complications, and the high degree of patient acceptance, we recommend this type of balanced anesthesia for patients undergoing shoulder surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery.
The goal of this randomized study of high-risk surgical patients was to determine whether intraoperative thoracic epidural anesthesia in combination with light general anesthesia alters postoperative morbidity when compared to a standard technique of "balanced" general anesthesia. A total of 173 patients scheduled for abdominal aortic reconstruction were admitted to the study; 86 were to receive "balanced" general anesthesia (group 1) and 87 thoracic epidural anesthesia in combination with light general anesthesia (group 2). Preoperative evaluation included standard clinical tools, dipyridamole thallium gammatomography, and radionuclide angiography. ⋯ In group 2, 6 patients with a nonfunctioning epidural catheter due to technical failure received a balanced general anesthesia and were eliminated from the study. During the postoperative period, group 2 received analgesia of subcutaneous morphine (n = 26), epidural fentanyl (n = 25), or epidural bupivacaine (n = 30). Cardiovascular morbidity did not differ between the two groups: 22 patients in group 1 and 19 patients in group 2 had a major postoperative cardiac event.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Clonidine decreases postoperative oxygen consumption in patients recovering from general anaesthesia.
Twenty ASA I patients, undergoing thyroid surgery were allocated randomly to receive at the end of surgery either an isotonic saline solution or clonidine 2 micrograms kg-1 i.v. administered over 20 min. Oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured during recovery in patients breathing spontaneously with a head canopy system. ⋯ The effect of clonidine was associated with a reduction in shivering. Sedative and analgesic properties of clonidine may also contribute to the reduction in metabolic demand during recovery from anaesthesia.
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We present the results of intraoperative monitoring of motor evoked potentials from 34 patients undergoing spinal surgery under total anesthesia with intravenously administered propofol. Intraoperative recording was performed with transcranial electrical stimulation. Two groups of patients were studied: 1) a control population of 26 patients undergoing lumbar discectomy for prolapsed intervertebral disc, all of whom had normal preoperative motor conduction; and 2) a population of 8 patients undergoing neurosurgical procedures for spinal tumor (5 patients) and spinal arteriovenous malformation (3 patients), all of whom had abnormal preoperative neurological signs and abnormal preoperative motor conduction. ⋯ Intraoperative monitoring was successful in 87% of the patients in the pathological group. We observed significant changes in both amplitude (greater than 50%) and/or onset latency (greater than 3 ms) from the intraoperative baseline that indicated either improvement (3 patients) or deterioration (2 patients) in motor conduction within minutes of surgical maneuvers anticipated to alter spinal cord function. Only permanent complete loss of intraoperative motor conduction (1 patient) correlated with a significant change in the postoperative neurological state.(ABSTRACT TRUNCATED AT 250 WORDS)