Articles: general-anesthesia.
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Case Reports
[Prolonged respiratory depression following general anesthesia in a patient with dystrophia myotonica].
A case of general anesthesia for a 52 year old female with previously undiagnosed dystrophia myotonica was reported. The patient was diagnosed as flaccid paralysis of the bilateral lower extremities but myotonic symptoms were not found preoperatively. The patient underwent duodenal resection to have a benign tumor removed. ⋯ The patient was examined again by a neurologist and a final diagnosis of dystrophia myotonica was made. Prolonged recovery from anesthesia and postoperative respiratory depression observed in this patient was due to preoperatively undiagnosed dystrophia myotonica. A careful preoperative examination should be made to minimize possible complication related to anesthesia in the disease.
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J Cardiothorac Anesth · Apr 1989
Clinical Trial Controlled Clinical TrialIntrapleural bupivacaine--technical considerations and intraoperative use.
The authors evaluated the incidence and type of technical problems associated with blind insertion of intrapleural catheters placed in 21 anesthetized patients and then injected in a double-blind fashion with 0.5% bupivacaine (1.5 mg/kg) or isotonic saline. The patients' chests were then opened, catheter positions located, and the lungs inspected. Eleven of the catheters were located with the tips intrapleurally, three extrapleurally, and seven actually in lung tissue. ⋯ It is concluded that blind insertion of intrapleural catheters can be hazardous, especially if followed by positive-pressure ventilation. In addition, catheter placement in lung tissue, which was not uncommon, delays the time for peak plasma concentrations and may increase risk of toxicity. Intrapleural bupivacaine was not found to be a useful adjunct to general anesthesia during thoracotomies.
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Critical care medicine · Apr 1989
Randomized Controlled Trial Clinical TrialTrendelenburg position and passive leg raising do not significantly improve cardiopulmonary performance in the anesthetized patient with coronary artery disease.
The effects of the Trendelenburg (TREND) position and passive straight leg raising (PLR) on cardiopulmonary performance in 18 anesthetized patients undergoing myocardial revascularization were studied with a two-dimensional transesophageal echocardiography probe and a thermodilution right ventricular ejection fraction (RVEF) pulmonary artery catheter. The TREND position (at 20 degrees) and PLR (at 60 degrees) were studied in relation to the level-supine position in random order. ⋯ PLR had similar effects as the TREND position, except CI did not change significantly. Thus, the TREND and PLR resulted in minor hemodynamic improvement with right ventricular dilation, decreased RVEF, and impaired oxygenation in the anesthetized cardiac surgical patient.
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Over the past decade, an array of monitoring devices have been developed to continuously assess patient oxygenation. While actual tissue oxygenation is the most desirable measurement, the pulse oximeter offers a non-invasive method of measuring oxygenation of arterial blood. In this study, the arterial oxygen saturation (SaO2) of children presenting for oral surgical procedures under general anesthesia was continuously monitored. ⋯ This study showed that 22.5 per cent of children significantly desaturated (SaO2 less than 90 per cent) during this period - a figure which is in complete agreement with several similar studies done recently. This desaturation preceded not only hemodynamic changes, but frequently changes in tissue and blood colour as well. The authors conclude that children should receive supplemental oxygen in the immediate recovery phase following general anesthesia.