Articles: general-anesthesia.
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Ann Fr Anesth Reanim · Jan 2007
Review[Anaesthetic management of adult patients with obstructive sleep apnea syndrome].
The purpose of this review article is to update the anaesthetic management of adult patients with obstructive sleep apnoea syndrome (OSAS). ⋯ Further research is needed in this field of anesthesia. Intraoperative difficulties in the control of airway and postoperative cardiac and respiratory complications may happen. The use of nasal CPAP in the perioperative period makes the anaesthetic management easier and safer.
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Curr Opin Anaesthesiol · Dec 2006
ReviewWhich muscle relaxants should be used in day surgery and when.
After myorelaxants, myalgia and residual curarization may complicate recovery. Local anaesthesia and minimally invasive airway management make myorelaxants disputable in many outpatient procedures; nevertheless, neuromuscular blockade may be necessary to facilitate intubation or maintain muscle relaxation. Agent selection criteria are discussed. ⋯ Ear-nose-throat, open eye surgery and laparoscopy may demand myoresolution. Regional and minimally invasive anaesthesia are alternative solutions. Central and peripheral nerve blocks are associated with increased induction time, reduced pain scores, and decreased need for analgesics. Central neuraxial block, however, is associated with prolonged outpatient unit stay. Bad intubating conditions may cause pharyngo-laryngeal complications: the decision to avoid myorelaxants for tracheal intubation appears illogical. Incidence of postoperative residual curarization remains very high. Sugammadex offers new perspectives.
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Obese patients are more and more frequently proposed for elective surgery, including acts specifically aimed at curing this condition, i.e. bariatric surgery. Many of these acts present characteristics compatible with ambulatory treatment, but anesthesiologists are reluctant to treat the morbidly obese as outpatients due to lack of data on the safety of this approach. The purpose of this review is to present the information that could be found in the literature on the safety and feasibility of ambulatory procedures in obese patients, and outline the specificity of this population. ⋯ Ambulatory care in the obese patient is both feasible and well suited to this population provided a few specificities are taken into account.
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The nature and mechanism of human consciousness is emerging as one of the most important scientific and philosophical questions of the 21st century. Disregarded as a subject of serious inquiry throughout most of the 20th century, it has now regained legitimacy as a scientific endeavor. The investigation of consciousness and the mechanisms of general anesthesia have begun to converge. In the present article I provide an introduction to the study of consciousness, describe the neural correlates of consciousness that may be targets of general anesthetics, and suggest an integrated approach to the science of consciousness and anesthesia.
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Review
Off-pump coronary artery bypass surgery: anaesthetic implications and the Trinidad experience.
To review the evolution of off-pump coronary artery bypass surgery with particular reference to the anaesthetic and perioperative implications. ⋯ Off-pump coronary artery bypass grafting surgery has distinct anaesthetic implications. In Trinidad and Tobago, the majority (85%) of the coronary revascularization surgeries are being done by this technique. Because of the lower cost and improved outcomes, this technique could be recommended to other developing countries of the region.