Articles: general-anesthesia.
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Core body temperature is one of the most tightly regulated parameters of human physiology. At any given time, body temperature differs from the expected value by no more than a few tenths of a degree. ⋯ Consequently, perioperative hypothermia leads to a number of complications including postoperative shivering (which unacceptably increases patients' metabolic rates), impaired coagulation, prolonged drug action, and negative postoperative nitrogen balance. In this review I will describe how anesthesia and surgery impair thermoregulation, the resulting changes in heat balance, and the physiological responses provoked by perioperative alterations in body temperature.
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An explanation of consciousness is one of the major unsolved problems of modern science. The modern view of consciousness arose in the nineteenth century; the view presumed that mental activity correlates with distinct physical states. Is the problem of consciousness real? Crick and Koch made a tentative assumption that all different aspects of consciousness (pain, seeing, thinking, emotion, self-consciousness) are connected by a basic common mechanism. ⋯ The introduction of safe general anaesthesia represents one of the most important, although under-appreciated, advances in modern surgery. There is some difficulty in defining the term "consciousness" in relation to the anaesthetic state. The difference in brain activity between those under anaesthesia and those not under any such influence.
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Cochrane Db Syst Rev · Oct 2008
Review Meta AnalysisLocal versus general anaesthesia for carotid endarterectomy.
Carotid endarterectomy reduces the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant perioperative risks which may be lessened by performing the operation under local rather than general anaesthetic. This is an update of a Cochrane review first published in 1996, and previously updated in 2004. ⋯ There is insufficient evidence from randomised trials comparing carotid endarterectomy performed under local and general anaesthetic. Non-randomised studies suggest potential benefits with the use of local anaesthetic, but these studies may be biased.
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Dexmedetomidine is a relatively selective alpha2 agonist with sympatholytic, sedative, amnestic, and analgesic properties. It is indicated for the short-term sedation of patients needing mechanical ventilation in the intensive care unit. ⋯ This article will provide the reader with a comprehensive review of the pharmacology, pharmacokinetics, and adverse effects of dexmedetomidine. A thorough understanding of this drug will enable the anesthesia provider to determine situations in which dexmedetomidine may be a useful drug to consider, whether as an adjunct or as a sole agent.
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Gastrointest. Endosc. Clin. N. Am. · Oct 2008
ReviewProviding safe sedation/analgesia: an anesthesiologist's perspective.
Over the past several years office-based procedures with sedation have become increasingly more common. It must be appreciated that not all procedures are well suited for this type of environment. ⋯ Since esophagogastroduodenoscopy (EGD) and colonoscopy are relatively non-invasive, of short duration, and not associated with either fluid shifts or significant post-procedure discomfort. In appropriate patients, these procedures are well-suited to office-based practice.