Articles: general-anesthesia.
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Several studies have shown that surgical patients cannot consciously recall or recognize events to which they had been exposed during general anesthesia. Might evidence of memory for intraoperative events be revealed through the performance of a postoperative test that does not require remembering to be deliberate or intentional? Results of the present study, involving the recognition and spelling of semantically biased homophones, suggest a negative answer to this question and imply that intraoperative events cannot be remembered postoperatively, either with or without awareness.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Vecuronium: onset of effect and intubation conditions in comparison to pancuronium and suxamethonium].
The onset of neuromuscular blockade following the i.v. injection of vecuronium and pancuronium 0.05, 0.08 or 0.1 mg/kg and suxamethonium 0.5 or 1.0 mg/kg was studied in 304 patients during induction of anaesthesia by means of the compound action potential derived from the adductor pollicis muscle, which was indirectly stimulated via the ulnar nerve. The intubation conditions 1-5 min after injection were assessed using a scoring system related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of extremities. Development of motor blockade was time- and dose-dependent. ⋯ Although suxamethonium acts the fastest and tracheal intubation can be achieved within 0.5-1.0 min, its use involves certain side effects and disadvantages. Vecuronium acts considerably faster than pancuronium and good or excellent intubation conditions are present within 2 min. Suxamethonium is no longer the muscle relaxant of choice for intubation except for crash intubation, e.g., in patients with a full stomach.
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J Bone Joint Surg Am · Dec 1985
Induced moderate hypotensive anesthesia for spinal fusion and Harrington-rod instrumentation.
The effect of moderate hypotensive anesthesia on blood loss, need for transfusion, and length of surgery of forty-nine patients who underwent posterior spinal fusion and Harrington-rod instrumentation was compared retrospectively. Twenty-seven patients were given enflurane as the main anesthetic agent, with fentanyl supplementation, and their blood pressure was maintained at twenty to thirty millimeters of mercury less than the preoperative systolic blood pressure. These patients were compared with twenty-two patients who had been anesthetized with nitrous oxide, oxygen, and narcotic technique and were normotensive throughout the duration of the anesthesia. ⋯ Moderate hypotensive anesthesia was found to significantly decrease the average blood loss by nearly 40 per cent, reduce the need for transfusion by nearly 45 per cent, and shorten the average operating time by nearly 10 per cent. No complications attributable to the anesthetic technique occurred. The findings of this study suggest that moderate hypotensive anesthesia with enflurane and fentanyl supplementation may be of benefit in scoliosis surgery by reducing blood loss, the need for blood replacement, and operating time.
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Comparative Study
[Atracurium: neuromuscular blockade in repeated administration].
The neuromuscular blocking action of repeated injections of atracurium and vecuronium was studied in 74 surgical patients during balanced anaesthesia (methohexitone or etomidate, intubation after suxamethonium, fentanyl, droperidol, N2O). The initial bolus dose (ID) of atracurium was 0.25 mg/kg and of vecuronium 0.05 mg/kg followed by repeated increments (RD) of atracurium 0.1 mg/kg and vecuronium 0.0125 mg/kg when neuromuscular function (EMG) had recovered to about 30% of pre-relaxant control. Dose-response relationships revealed atracurium to be about 1/5 as potent as vecuronium; the ED50 of atracurium was 0.13 +/- 0.03 mg/kg and of vecuronium 0.023 +/- 0.007 mg/kg. ⋯ Neither cardiovascular side-effects nor signs of histamine release were observed after both relaxants in our particular dose range. It is concluded, that atracurium is a favourable blocker for anaesthetic practice: The time of onset is approximately the same compared with vecuronium. The duration of action, however, is slightly longer but still truly intermediate long.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Halothane hepatitis without halothane: role of inapparent circuit contamination and its prevention.
Halothane and other halogenated anesthetic agents are liquids which are highly soluble in rubber and plastic materials widely used as components of anesthesia machines. These agents must be administered using machines equipped with vaporizers. We report a patient with a past history of halothane hepatitis in whom recurrence was suspected despite the fact that halothane had been avoided purposely during the subsequent operation. ⋯ The validity of this conclusion was confirmed in five patients with previous diagnosis of halothane hepatitis who subsequently underwent operations under general anesthesia during which machines never equipped with vaporizers were successful in preventing recurrence of hepatitis. We conclude that patients with a prior history of halothane hepatitis are at risk of inapparent circuit contamination-induced recurrent hepatitis. Unless such contamination can be confidently excluded, vaporizer-equipped machines should not be used to administer general anesthesia in these susceptible patients.