Articles: general-anesthesia.
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Cahiers d'anesthésiologie · Mar 1986
[Controlled hypotension during posterior vertebral arthrodesis; value of an isoflurane-nitroglycerin combination].
Eighteen young patients (mean age +/- SD 15.9 +/- 3.3) scheduled for operative treatment of idiopathic scoliosis (posterior spine fusion) were studied during surgery. Deliberate hypotension (MAP less than 60 mm Hg) of long duration (greater than 2 hours) was induced using isoflurane and nitroglycerin. Hypotension was effective in less than 15 min in all patients. ⋯ Intra operative awakening was obtained 22.8 +/- 3.7 min after isoflurane was discontinued. Isoflurane and nitroglycerin produce a stable and safe hypotension with no major hemodynamic disturbances. Isoflurane has to be discontinued 20 min before the wake-up test.
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A patient with Friedreich's ataxia was anaesthetised on two occasions. The neuromuscular blocking agent was atracurium 0.5 mg/kg on the first occasion and tubocurarine 0.5 mg/kg on the second. ⋯ This patient did not demonstrate an abnormal response to either relaxant; the operating conditions were satisfactory and recovery was not delayed. These drugs may be safely used in this condition provided that monitoring is adequate.
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Blood glucose levels were measured immediately after induction of anaesthesia and again intraoperatively in 26 children fasted overnight for operations in the morning and 28 children fasted from 8.00 a.m. for afternoon surgery. The mean post-induction glucose concentration of the afternoon surgery group was significantly lower than that of the morning group. ⋯ Anesthesia and surgery caused significant increases in blood glucose levels. It is concluded that pre-operative fasting is well tolerated in healthy pre-school children, regardless of the timing of surgery.
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Acta Anaesthesiol Scand · Feb 1986
Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis.
Pulmonary gas exchange and the development of atelectasis were studied in eight essentially lung-healthy patients, awake and during halothane anaesthesia with mechanical ventilation. Gas exchange was evaluated by a multiple inert-gas elimination technique and conventional blood-gas analysis, and atelectasis was studied by computerized tomography (CT). Ventilation and lung perfusion were well matched in the majority of the patients when awake. ⋯ Densities in dependent lung regions (interpreted as atelectasis) were seen on the CT scans in six patients. The extent of atelectasis was significantly correlated both to the magnitude of shunt (r = 0.93, P less than 0.01) and to the impairment of arterial oxygenation (r = 0.99, P less than 0.001). The findings indicate that atelectasis in dependent lung regions during halothane anaesthesia creates shunting of blood flow and that atelectasis is the major or sole cause of impaired gas exchange in the lung-healthy, anaesthetized subject.