Articles: general-anesthesia.
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Historical Article
Early use of general anesthesia in Alabama, 1847 to 1853.
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Children with neurological and neuromuscular diseases often present anesthetic problems in the perioperative period. The anesthetic technique can play a significant role in altering the state of the brain during neurosurgical procedures through effects on the cerebral circulation and metabolism. Pre-existing neuromuscular disease may also have specific anesthetic implications such as cardiorespiratory involvement (eg, myotonia dystrophica), the potential for drug interactions (eg, myasthenia gravis) or abnormal responses to commonly used drugs (eg, malignant hyperthermia). In this review, the perioperative anesthetic considerations in a number of common neurological and neuromuscular conditions in the pediatric patient are discussed.
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Anesthesia and analgesia · Jul 1986
Wakefulness during cesarean section after anesthetic induction with ketamine, thiopental, or ketamine and thiopental combined.
Thirty-six pregnant women (ASA class I or II) at term who underwent general anesthesia and cesarean section received either ketamine, 1 mg/kg (n = 12); thiopental, 4 mg/kg (n = 13); or a combination of ketamine, 0.5 mg/kg, and thiopental, 2 mg/kg (n = 11). A blood pressure cuff inflated to 250 mm Hg isolated one arm from the effects of succinylcholine so that awareness during anesthesia could be assessed by asking the patient to move her hand. Although only one patient receiving ketamine responded to commands during anesthesia, 46% of patients receiving either thiopental or the combination responded to commands intraoperatively. ⋯ Three patients (8%) had postoperative recall of intraoperative awareness; one had received thiopental and two the combination. Maternal intraoperative cardiovascular responses among the groups were similar, as were umbilical blood gas values, newborn Apgar scores, and neonatal neurobehavioral test scores at 4 and 24 hr. Ketamine more effectively blocked maternal responsiveness to commands and strong stimuli during the first few minutes after anesthetic induction for cesarean section than did thiopental or a combination of thiopental and ketamine, each at a lower dose.
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Int Clin Psychopharmacol · Jul 1986
Adverse cognitive effects of general anaesthesia in young and elderly patients.
For many years, reports have appeared indicating cognitive deficits in elderly patients following anaesthesia. However, there is no general consensus of opinion concerning the putative relationship between these deficits and the anaesthetic process. In a prospective study, 85 patients undergoing elective surgery were assessed on a battery of standardized cognitive tests, 1 day before and 2 days after surgery. Analysis of results indicated that anaesthesia does produce post-operative cognitive deficits in both young and elderly patients, and a possible causative mechanism is discussed.