Articles: anesthetics.
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The place of computerization in intravenous anaesthesia delivery: Although total intravenous anaesthesia may have advantages over inhalational anaesthesia in certain circumstances, it has drawbacks from the point of view of feedback control. The ideal agent is not available, although di-isopropylphenol holds promise. There is an undefinable end-point. ⋯ The anaesthetist is still required for, amongst other things, specifying the desired depth of anaesthesia and varying it during the operation, and for responding to unforeseen crises. It may be hoped that, by liberating the anaesthetist from those tasks which can be automated, more time can be devoted to patient monitoring and other aspects of anaesthetic care, thereby improving patient safety. There is an undoubted place for computerized delivery of anaesthesia in teaching (particularly teaching pharmacokinetic principles) and in research (for standardization of anaesthetic depth).
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Local anesthetics are remarkably useful agents that enhance patient comfort and improve patient compliance. Their use, however, requires an understanding of their action, proper dosages, potential risks, and treatment of reactions. We have presented the history, pharmacokinetics, action, risks of using, and ways in which agents are used to treat the most common agents, with notes on the special aspects of each agent. With the increased awareness that these are, indeed, not benign substances, we hope that serious reactions can be avoided by prophylactic measures and proper treatment in the early stages of toxicity.
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Acta Anaesthesiol Belg · Dec 1985
Randomized Controlled Trial Comparative Study Clinical TrialA hemodynamic study of epidural versus intravenous anesthesia for aortofemoral bypass surgery.
The hemodynamic effects of two types of anesthesia on aortofemoral bypass surgery were studied in a randomised prospective trial. Epidural anesthesia supplemented with nitrous oxide (group I) and total intravenous anesthesia combining fentanyl and a continuous infusion of etomidate (group II) were compared. A high incidence of preoperative disease was found and all 18 patients were classified in ASA classes III-IV. ⋯ Cardiac work was higher in the intravenous group due to the high impedance of the cardiovascular system provoked by the absence of vasodilatory properties with this type of intravenous anesthesia. Monitoring of PWP and CI by Swan-Ganz catheter is shown to be very useful for optimalization of hemodynamics and fluid management especially during crossclamping, when normal Frank-Starling relationships might not be valid anymore. The effect of vasodilatory treatment, crossclamping and declamping could be carefully evaluated.