Articles: general-anesthesia.
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When we ask, what renders essential a particular monitoring approach during routine anesthesia for a healthy patient, perplexing questions, rather than satisfying answers, are raised. I have examined these questions with the help of three lenses that focus on the relationship between the outcome of anesthesia and the detection, and thus correction, of abnormalities during anesthesia. The first lens looks at whether the monitoring modalities accepted by anesthesiologists as "minimal" and "essential" have been scientifically proven to affect outcome from routine anesthesia. ⋯ The third lens looks at whether there are nonclinical influences on monitoring practice. This lens views the gap between recognizing monitoring possibilities and adopting them clinically; it also views geographic differences in monitoring, as well as social pressures exerted through legal proceedings. Finally, currently recognized essential monitors such as blood pressure measurement, electrocardiography, and oxygen analysis are mentioned, and candidates for inclusion in the list of essential monitors, such as oximeters, capnographs, and the automated record, are discussed.
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A study was conducted to measure the pressure in the middle ear in healthy children, following nitrous oxide anaesthesia. Premedication with chloral hydrate and scopolamine orally was similar in all patients and awake patients received thiopentone 4-5 mg X kg-1 for induction of anaesthesia. ⋯ All patients developed negative pressure in one or both ears in the first day following anaesthesia. This is a higher incidence than previously reported and may be explained by the inability of children to equilibrate negative middle ear pressure via the eustachian tube.
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Randomized Controlled Trial Clinical Trial
Hemodynamics of the legs and clinical symptoms following regional blocks for transurethral surgery.
In a prospective clinical study we compared the hemodynamics and clinical symptoms following regional blocks and general anesthesia. 115 patients undergoing transurethral resection of the prostate were randomized to spinal (n = 62) and epidural (n = 53) blocks. An additional 10 patients received general anesthesia. Calf arterial flow, determined by strain gauge plethysmography (SGP), was similar pre- and postoperatively in the regional block groups but decreased in the general anesthesia group (p less than 0.05) on the 5th postoperative day compared to the preoperative day. ⋯ Antiembolism stockings offered no hemodynamic or clinical advantages. During the hospital stay (screening by Doppler and SGP) and 3 months of follow-up, no deep vein thrombosis or pulmonary embolism was diagnosed. 3 months after the operation, unspecific pain and/or weakness in the legs were reported by 12 patients in the spinal group, while the epidural group remained asymptomatic (p less than 0.01). We conclude that the predictive value of negative Doppler and SGP findings is good and that spinal and epidural blocks are hemodynamically advantageous as compared to general anesthesia.