Articles: general-anesthesia.
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Regional-Anaesthesie · Jan 1984
Comparative Study[Comparative studies on general anesthesia versus peridural anesthesia in primary cesarean section].
In a prospective interdisciplinary study involving the departments of gynaecology, anaesthetics and paediatrics, the influence on both the mother and neonate of general as opposed to epidural anaesthesia was compared in 47 planned caesarean sections. Neither maternal or foetal risk factors were present in these cases, and the cardiotocogram was always normal before the anaesthetic was applied. Methods. ⋯ Acid-base and PCO2 values were not markedly influenced by either of the techniques used, but the maternal capillary PO2 levels were very much higher in the general anaesthetic group. The neonates born under general anaesthetic had a lower 1 min Apgar score, as a result of the relatively long induction-delivery time, of on average 17 min. The 5 and 10 min Apgar scores and the neurophysiological development of the babies revealed no differences between the two groups.
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The most important complications following gastrointestinal surgery are related to disruption of anastomoses. The fate of a gastrointestinal anastomosis is influenced by many factors. Among these, care in the anaesthetic management and postoperative treatment may reduce the incidence of complications. ⋯ The prevention of high intra-luminal pressures and excessive longitudinal traction across anastomoses may be aided by care in the administration of neostigmine, and possibly by the avoidance of morphine for provision of intra-operative and postoperative analgesia. Maintenance of, or improvements in, oxygen supply to an anastomosis may be achieved by avoiding hypoxia, hypocapnia and hypovolaemia, and by the use of regional anaesthetic techniques during surgery and/or in the post-operative period. In addition, sedative and analgesic therapy may influence the incidence of postoperative ileus, and may thus contribute to morbidity.
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A review of the literature and of our recent data (obtained by computer-based analysis of multiple inert gas elimination) re-emphasizes the significant gas exchange disturbances found to occur during general anesthesia which develop for probably several reasons. In this report we suggest firstly that the reduction in functional residual capacity (FRC) may well be an effect of anesthesia just as is abnormal gas exchange. In other words, the reduction in FRC is not per se the cause of gas exchange disturbances, but rather occurs alongside them. ⋯ Such factors include altered hypoxic vasoconstriction, a change in airway secretions and clearance of those secretions, changes in bronchomotor tone, changes in surfactant activity, and alveolar volume loss due to rapid uptake of soluble anesthetic gases like nitrous oxide. To qualitatively and quantitatively distinguish amongst these various potential factors will require experimental protocols and techniques of a highly controlled and accurate nature. That in 1983 we still do not understand the basic mechanisms behind abnormal gas exchange during anesthesia attests to the difficulty of mounting such an experiment.
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Case Reports Comparative Study
Anaesthesia for patients with multiple sclerosis.
The types of anaesthesia administered to 56 multiple sclerosis patients undergoing surgery in the different departments of the Helsinki University Central Hospital (HUCH) during a ten year period from 1973 to 1982 were studied. The perioperative and postoperative events were analyzed in relation to the method of anaesthesia. ⋯ In four patients who were given regional anaesthesia (2 spinal, 3 epidural) marked by hypotension, quite resistant to intravenous vasopressor treatment was observed. No deterioration of the multiple sclerosis was noted postoperatively which could be related to the anaesthesia.