Articles: general-anesthesia.
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Anasth Intensivther Notfallmed · Aug 1988
[The reliability of pulse oximetry monitoring of arterial oxygen saturation in centrally intubated and hypothermic patients].
The present study tests the effectiveness of pulse oximetric measurement in attaining reliable saturation values even in patients with hypothermia and centralization. 20 patients who had all required endoprosthetic surgery of the lower extremities were included in the study. During the process of removing 98 samples for arterial blood-gas analysis, pulse oximetric saturation, heart rate (pulse oximeter and ECG), rectal temperature, peripheral temperature at the back of the fingers, arterial pressure (catheter) and central venous pressure were registered. The results can be summarized as follows: 1. ⋯ In the area examined, the reliability of pulse oximetric measurement is influenced neither by blood pressure fluctuations nor by intravascular hypo- or hypervolemia. 4. There is merely a sharp increase in the Pulsoximeter when the temperature decreases. The Pulsoximeter still indicates the correct saturation as long as the peripheral pulse rate corresponds to the heart rate on the ECG Monitor.
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This review describes the distribution of ventilation and blood flow in the anaesthetized subject, during spontaneous breathing and after muscle paralysis. Within minutes after induction of anaesthesia, the diaphragm is shifted cranially (supine position), functional residual capacity is reduced and collapse of dependent lung regions can be seen by means of computed tomography. These changes occur whether anaesthesia is intravenous (barbiturate) or inhalational (halothane) and whether ventilation is spontaneous or mechanical. ⋯ This causes a ventilation/perfusion mismatch, the hall-mark of which is shunt. Additional factors such as airway closure and release of hypoxic pulmonary vasoconstriction may contribute to the gas exchange disturbance. The major features of the lung function impairment are already present during spontaneous breathing in the anaesthetized subject, and muscle paralysis adds only little to the disturbance.
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Case Reports
Atypical malignant hyperthermia with persistent hyperkalaemia during renal transplantation.
A 35-year-old 110 kg male developed marked hyperkalaemia, hyponatraemia, hypercapnia and hyperthermia during living-related renal transplantation under anaesthesia with oxygen-nitrous oxide, isoflurane and muscle relaxation with atracurium. This is the first report of successfully treated malignant hyperthermia triggered by isoflurane during renal transplantation with early appearance and persistent (to 12 hours after surgery) electrolyte abnormalities.
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The use of dantrolene to reverse severe unexplained postanaesthetic muscle rigidity in a previously "healthy" 13-year-old male is described. Anaesthesia was induced with thiopentone. After intubation with pancuronium, the patient had an entirely uneventful nitrous oxide, oxygen and halothane anaesthetic. ⋯ The symptoms responded to IV dantrolene in a total dose of 2.0 mg.kg-1. Further testing failed to establish a definite diagnosis. Dantrolene could be a useful drug in treating such unexplained muscle rigidity.