Articles: general-anesthesia.
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The effects on the haemodynamic and biochemical parameters of three different anaesthetic induction regimes, namely fentanyl (4.1 micrograms.kg-1 or 15 micrograms.kg-1) plus 60 per cent nitrous oxide with oxygen and fentanyl 15 micrograms.kg-1 plus 60 per cent nitrogen with oxygen, were studied in patients undergoing coronary artery surgery. Fentanyl 15 micrograms.kg-1 with nitrous oxide and oxygen produced simultaneous reductions in oxygen uptake, cardiac index and left ventricular stroke work with an unaltered oxygen extraction. Diastolic blood pressure (an index of coronary artery perfusion) was only slightly reduced, and there were no changes in arterial lactate, glucose and free fatty acids. ⋯ The patients receiving fentanyl 15 micrograms.kg-1 with nitrogen and oxygen showed increases in heart rate, blood pressure, cardiac index and left ventricular stroke work, together with a significant fall in oxygen extraction. Moreover, in the patients who received fentanyl 4.1 micrograms.kg-1 with nitrous oxide and oxygen and fentanyl 15 micrograms.kg-1 with nitrogen and oxygen there were significant increases in blood lactate, glucose and free fatty acids, indicating increased sympathetic activity. We conclude that fentanyl 15 micrograms.kg-1, together with 60 per cent nitrous oxide with oxygen provides a satisfactory haemodynamic and biochemical state during induction of anaesthesia in patients with myocardial function prejudiced by coronary artery insufficiency.
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The authors reviewed the records of seventy preterm infants suffering from respiratory distress syndrome and, in most cases, refractory congestive heart failure, who underwent ligation of patent ductus arteriosus. The peri-operative management of these patients is described. The anaesthetic technique consisted of nitrous oxide and oxygen supplemented with a relaxant. ⋯ The infants were protected from significant temperature fluctuations by various methods which are described. The overall survival rate of all preterm infants with respiratory distress syndrome. The management presented is considered acceptable to the infants, to the surgeons and to the anaesthetists.
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Minerva anestesiologica · Apr 1980
Comparative Study[Delivery by cesarean section under general anesthesia and the neurobehavioral assessment of the newborn infant].
The problem of the effects on newborns of the anaesthetics administered to the mother has been reviewed. For research purposes Pentothal, widely used for induction in Caesarean section was considered. In spite of the presence of fair quantities of this drug, as demonstrated by foetal blood withdrawn from the umbilical cord, the newborns examined and submitted to painstaking neuro-behavioral assessment using Brazelton's method, did not show any signs of neurological impairment nor diversity in behaviour compared to a control group.
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A retrospective examination of all maternal deaths at Queen Charlotte's Hospital in the last 20 years shows that general anaesthesia is the greatest single cause of maternal death. This highlights the need for considerable reduction in the inherently dangerous technique of general anaesthesia to patients in labour and, where possible, its replacement by extradural and spinal blocks.