Articles: general-anesthesia.
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The anaesthetist giving anaesthesia for the surgical removal of cerebral aneurysms faces a great variety of tasks. Experience gained in the course of 61 such operations has shown that a combination of controlled hypotension, careful monitoring of the function of the autonomic nervous system and a meticulous surgical technique with the aid of a microscope produces satisfactory results.
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Comparative Study
Maternal and neonatal effects of methoxyflurane, nitrous oxide and lumbar epidural anaesthesia for Caesarean section.
General anaesthetic techniques continue to be used for Caesarean section despite the possible increased incidence of foetal acidosis and neonatal depression. Two techniques of general anaesthesia (methoxyflurane-oxygen and nitrous oxide-oxygen) and lumbar epidural anaesthesia were compared in 37 patients under-going elective Caesarean section. ⋯ Cord blood gas analysis showed the babies in the methoxyflurane group to have a higher PaO2 with less metabolic acidosis than the babies from the other two groups. The maternal effects of the three anaesthetic techniques were similar, with only a small rise in serum fluroide levels noted in the methoxyflurane group.
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Halothane-nitrous oxide-oxygen (GOF), nitrous oxide-oxygen with diallyl-nor-toxiferine (Jackson-Rees method), or nitrous oxide-oxygen with droperidol-pentazocine (modified NLA) were administered in 190 instances of repair of cleft lips and cleft palates. Epinephrine, 1:30,000, 1:100,000, or 1:300,000, was injected as the vasoconstrictor around the operative field. Epinephrine concentration of 1:100,000 provided sufficient hemostasis, whereas 1:300,000 was insufficient. ⋯ Propranolol was given in only one instance. All others returned to normal rhythm with hyperventilation with pure oxygen. The use of 1:100,000 solution of epinephrine as an adjunct with modified NLA is the most satisfactory and safe method for cleft palate operations, and 1:30,000 with the Jackson-Rees is the better method for cleft lip repairs.
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Caesarean sections were performed on 18 Romney ewes on day 144 of pregnancy. Anaesthesia was induced in 9 ewes with CT 1341 and in 9 ewes with thiopentone and maintained in both groups with halothane administered with oxygen. Surgery was performed with the ewes in lateral recumbency, with respiration unassisted. ⋯ Significant linear relationships were only found in the CT 1341 group between TSR interval and PCO2 and pH. No significant correlations were found between the lD interval and any of the biochemical characteristics. The results of this study suggest that lateral recumbency does not interfere with uteroplacental circulation, that CT 1341 (2.2 mg/kg) is associated with less neonatal depression than thiopentone (10 mg/kg) and that severe neonatal hypercarbia may delay the onset of respiration in lambs with minimal drug depression.