Articles: general-anesthesia.
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This brief review presents an update of studies on postoperative fatigue and convalescence and the way in which they are affected by anesthetic technique. Development of postoperative fatigue is related to the degree of surgical trauma, but not to general anesthesia, and it cannot be predicted from age, sex, duration of surgery, or preoperative assessment of various nutritional parameters. Postoperative fatigue correlates with deterioration in nutritional status and impaired adaptability of heart rate to orthostatic stress and bicycle exercise. ⋯ Pain relief with regional anesthetics does not improve postoperative fatigue after abdominal surgery; however, no studies are available that evaluate the effects of regional analgesia with concomitant inhibition of the stress response. Controlled studies suggest that the use of regional anesthesia with local anesthetics reduces duration of hospitalization and time to ambulation. Further studies are needed to define the relative roles of immobilization, impaired nutritional intake, and surgical stress response in the pathogenesis of postoperative fatigue.
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Acta Chir Scand Suppl · Jan 1989
Comparative StudyCombined epidural and general anesthesia versus general anesthesia in patients having colon and rectal anastomoses.
Three retrospective studies were conducted at St. Vincent's Hospital to compare the outcomes of colorectal anastomoses, with and without resections, with respect to anesthetic technique. Operations were performed upon patients anesthetized with either combined regional (epidural) and general anesthesia (CRAG) or general anesthesia alone (GA). ⋯ Overall, anastomotic leak rates and death rates were lower in the CRAG group, and the lowest incidence of anastomotic leak was reported in the patients receiving CEA. Thus the reduced leak rate was associated more with the postoperative analgesia regimen than with the anesthetic technique. An increased incidence of wound dehiscence occurred with postoperative epidural morphine analgesia.
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Acta Anaesthesiol Belg · Jan 1989
Randomized Controlled Trial Comparative Study Clinical TrialA contribution to the monitoring of neuromuscular blockade: an evaluation of the Datex Relaxograph.
The Datex Relaxograph is a neuromuscular transmission monitor, which measures the degree of neuromuscular blockade during anesthesia. In order to evaluate the reliability of the Relaxograph, results, obtained with this apparatus, were compared with simultaneous mechanical measurements obtained with the Myograph 2000 (Biometer). Although there was a good correlation between the two throughout the study, a shift towards mechanical responses was observed in all cases. ⋯ Results show that neither drug offers major clinical advantages over the other. In a third study, a new bolus-constant infusion regimen of atracurium was evaluated. Results show that it produces a predictable and stable neuromuscular blockade.
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Ann Fr Anesth Reanim · Jan 1989
Review[Continuous monitoring of mixed venous oxygen saturation in anesthesia in pulmonary surgery].
The multiplicity of potential causes of variations in mixed venous oxygen saturation (SvO2) during one lung ventilation (OLV), including a constant ventilation/perfusion mismatch, explains that it has been suggested as a routine monitoring procedure. To assess its usefulness, 12 adults undergoing OLV were monitored during surgery with an Oximetrix pulmonary catheter, placed on the side opposite to the surgical field under fluoroscopic control. Seventy two complete sets of haemodynamic measurements were obtained at 6 different times during surgery. ⋯ SvO2 had low Se and Sp for changes in other variables (CO: 76 +/- 7, 48 +/- 9; PaO2: 79 +/- 6, 59 +/- 9; VA: 54 +/- 7, 48 +/- 7 respectively). In this type of surgery, alterations in variables related to oxygen are probably balanced by haemodynamic changes. In fact, according to Fick's formula, SvO2 is almost completely determined by SaO2 and CO, when VO2 and haemoglobin remain stable.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1989
Review[Treatment of malignant hyperthermia crisis during anesthesia].
Malignant hyperthermia (MH), triggered by anaesthesia, is a rare and potentially fatal condition. It requires immediate and specific treatment. This review focuses on anticipation and organisation of treatment. ⋯ A rational approach to the treatment of hyperkalaemia, circulatory and renal failure is discussed. After the crisis, dantrolene should be continued for a short time. Finally, the nonspecific signs which can give the earliest diagnosis possible of MH are discussed: an early diagnosis and early treatment with dantrolene are essential in reducing the mortality of malignant hyperthermia.