Articles: general-anesthesia.
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Direct measurements of systolic, diastolic, and mean arterial blood pressure and electrocardiogram-derived heart rates were compared with indirect arterial blood pressure measurements using the Dinamap 847XT noninvasive monitor. A total of 260 paired comparisons from 16 patients were analyzed. ⋯ The 95% confidence limits for systolic, mean, and diastolic arterial pressure were +/- 16 mm Hg, +/- 18 mm Hg, and +/- 21 mm Hg, respectively. The Dinamap monitor was found to be an accurate trend recorder of heart rate and blood pressure during anesthesia in neonates and small infants.
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There must be close cooperation between the surgeon and the anaesthetist during surgery of the paranasal sinuses. The surgeon needs a bloodless field which the anaesthetist can achieve by lowering the patient's arterial blood pressure using controlled hypotension. ⋯ There are two hypotensive drugs of choice: sodium nitroprusside and nitroglycerin. If the circulation and ventilation are monitored sufficiently, the surgeon can expect good results with diminished blood loss.
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An exercise in quality assurance during neuroanaesthetic procedures identified uncontrolled re-use of armoured latex rubber tracheal tubes as a risk factor associated with equipment failure. We recommend that such tubes should be used once only. Alternatively, tubes made from more stable materials, such as polyvinyl chloride and silicone rubber, are available for clinical evaluation.
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Despite considerable information and discussion about the risk of serious complications in patients with systemic mastocytosis undergoing general anaesthesia, little is known specifically about the risk to patients with isolated cutaneous mastocytosis. The experience of 29 general anaesthetics in 12 children with urticaria pigmentosa and three with solitary cutaneous mastocytoma was reviewed. No major complications were encountered and the four minor problems seen were self-limiting. The data from this study do not suggest that patients with urticaria pigmentosa or solitary cutaneous mastocytoma are at increased risk of life-threatening complications under general anaesthesia.