Articles: general-anesthesia.
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Anasth Intensivther Notfallmed · Feb 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Total intravenous anesthesia using propofol and alfentanil in comparison with balanced anesthesia in neurosurgery].
Anaesthesia for neurosurgical patients should provide haemodynamic stability, reduce cerebral metabolism, preserve cerebral autoregulation, avoid increases of intracranial pressure and guarantee rapid recovery without respiratory depression. A commonly used Balanced Anaesthesia (BA, n = 20) (thiopental and fentanyl bolus induction and maintenance with repetition boluses of fentanyl and droperidol, thiopental infusion, and isoflurane in N2O/O2) was compared to Total Intravenous Anaesthesia (TIVA, n = 20) with propofol and alfentanil infusion. Pancuronium was employed for muscle relaxation in both groups. ⋯ Quality of recovery after the procedure was determined by standardised psychometric tests. The time span between awakening of patients to orientation and concentration was significantly shorter in the TIVA group compared to the BA group. There was also a smaller deviation of these parameters in the TIVA group indicating a more predictable recovery.
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In a study of 247 patients who had general anaesthesia for dental procedures, the incidence of individual anxieties was noted using a questionnaire completed by the patient. The most common anxieties related to the period before transfer to the operating theatre, intra-operative awareness and postoperative pain. ⋯ The follow-up questionnaire was completed by 207 patients in order to indicate which anxieties they would expect to have if they needed anaesthesia in the future. All anxieties were less frequent than found before operation.
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Tidsskr. Nor. Laegeforen. · Jan 1990
[Registration of problems during anesthesia. Analysis of risk factors and quality control].
Society continues to increase its demands on the medical profession in regard to quality. We believe this situation should be met by a more systematic approach to risk evaluation and quality assessment of our work. We report an attempt to establish a routine system for recording complications during anesthesia. ⋯ Problems such as drop in blood pressure, intubation, laryngeal spasm and cardiac arrhythmias dominated. Such registration increases awareness for the safety of the patients, and enables us to assess the risk and evaluate the quality of our work. The system is now an integral part of the department's routine.
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Tidsskr. Nor. Laegeforen. · Jan 1990
[Causes and risk factors of intraoperative anesthesia complications. A prospective study of 14,735 anesthesias].
Identification of risk factors is an essential part of our efforts to minimize problems during anesthesia. 14,735 patients were included in a prospective study in order to assess the magnitude of risk and identify risk factors. The rate of complications increased substantially after the age of 40, due mainly to a large number of patients with poor preoperative physical condition. High age in itself was not associated with increased risk of complications. ⋯ The complications were related to the conduct of anaesthesia in 70% of the total number of cases and to poor physical status and the surgery in 30%. However, poor physical condition and the surgery were responsible for 50% of the very serious complications and for all the four deaths on the table. The results of the survey confirm that thorough preoperative preparation of the patient is extremely important in order to reduce intraoperative risk, especially in emergency surgery.
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Two patients with dystrophia myotonica presented for urgent Caesarean section. Their per- and postoperative courses illustrate the anaesthetic problems posed by this disease. ⋯ Choice of anaesthetic agent is discussed. Both had general anaesthetics; muscle relaxation was achieved with vecuronium.