Articles: general-anesthesia.
-
Int Anesthesiol Clin · Jan 1981
ReviewHypoxemia and general anesthesia: an analysis of distribution of ventilation and perfusion.
There is now overwhelming evidence that anesthesia with and without muscle paralysis is associated with an increased inefficiency of gas exchange, with abnormal oxygenation and CO2 elimination. There is great variation in the degree of this change from individual to individual; it results from increased right-to-left intrapulmonary shunting, increased alveolar dead space, increased dispersion of VA/Q ratios, altered cardiac output, and changes of the ODC. In normal subjects the abnormality can be largely explained by mismatch of ventilation and perfusion. ⋯ They can persist, however, well into the postoperative period. Alterations of pulmonary function during anesthesia and surgery are rarely life threatening in the operating room. Awareness of the problems of hypoxemia during general anesthesia and an appropriate response by the anesthesiologist, however, is a prerequisite of good medical practice.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparative influences of epidural and general anaesthesia on deep venous thrombosis and pulmonary embolism after total hip replacement.
In an investigation on deep venous thrombosis and pulmonary embolism, where neither dextran nor antithrombotic drug prophylaxis were employed, 30 patients undergoing total hip replacement were randomly allotted to one of two groups receiving either epidural or general anaesthesia. The epidural group (n = 15) was given 0.5% bupivacaine with epinephrine (5 micrograms/ml) and this was prolonged into the postoperative period for pain relief. The general anaesthesia group (n = 15) was operated on under artificial ventilation with nitrous oxide/oxygen via an endotracheal tube and intravenously administered fentanyl and pancuronium bromide. ⋯ Further, the frequency of pulmonary embolism, as determined by pulmonary perfusion lung scanning, was lower in patients receiving continuous epidural block (2 of 15) than in the general anaesthesia group (7 of 15). Possible explanations for these findings are discussed, including a hyperkinetic lower limb blood flow and lower fibrinolysis inhibition activity in patients given epidural block. Lower blood transfusion requirements in patients given epidural block might also play a role, as well as a "stabilizing" effect of local anaesthetics on platelets, leukocytes and endothelial cells.
-
A rare case of bilateral vocal cord paralysis after orotracheal intubation and inhalation anesthesia, in surgery not in relation to the neck, is presented. There was no obvious cause for the paralysis and possible etiological factors are discussed. Overextension of the neck during intubation is suspected of being the etiological agent causing stretching of both the vagus nerves. Normal laryngeal function returned after two months.
-
Anesth Analg (Paris) · Jan 1981
[Intervention among patients with right bundle branch block and left anterior hemiblock. Operatory risk (author's transl)].
In order to assess the risk of advanced heart block during anesthesia in patients with right bundle branch block and left anterior hemiblock, 35 consecutive patients were monitored throughout the pre-, intra- and postoperative period. As conventional ECG monitoring may only detect advanced atrioventricular block, patients were monitored according to the Holter method which can easily detect even minor changes of atrioventricular conduction namely slight increased PR interval or dropped P wave. All patients were asymptomatic, in normal sinus rhythm without second degree AV block. ⋯ They immediately regressed at the termination of the sinus bradycardia either spontaneously or following atropine injection, strongly suggesting the responsability of increased vagal tone. Thus general or epidural anesthesia did not compromise infranodal conduction in any of the observed patients. These data indicate that anesthesia can be safely used without prophylactic preoperative insertion of pacemakers in patients with asymptomatic chronic right bundle branch block and left anterior hemi-block.