Articles: general-anesthesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1996
Review[Is remifentanil an ideal opioid for anesthesiologic management in the 21st century?].
Current trends toward outpatient surgery and closed loop computer controlled drug administration have created a demand for short acting anaesthetic agents. Such agents not only provide the anaesthetist with rapid patient recovery after completion of the procedure, but also with almost immediate intra-operative control over the anaesthetic state of the patient. Shorter acting anaesthetic agents are being developed in several therapeutic areas including volatile anaesthetics, neuromuscular blockers as well as injectable anaesthetics. ⋯ Reducing the infusion rate of remifentanil to analgesic doses suitable for the postoperative pain management or immediate administration of longer acting opioids at the end of anaesthesia might solve this problem. At present it is difficult to predict precisely the future ranking of remifentanil. However, the unique pharmacokinetic profile of remifentanil should make it useful in the various surgical settings and in all circumstances where precise control over the analgesic state are desirable.
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A great deal of new information on alpha 2-adrenoceptor agonists has recently been accumulated in humans; alpha 2-agonists have several beneficial actions in clinical anesthesia including sedative, anxiolytic as well as analgesic effects, improved hemodynamic stability, and etc. In the first part of this review, we summarized the structure, signal transmission and basic pharmacology of alpha 2-adrenoceptor agonists (clonidine and dexamedetomidine), and evaluated their usefulness for premedication, and as anesthetic adjuvants as well as agents for stabilizing circulation in the clinical settings. In addition, we referred to practical problems associated with their use.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1996
[Perioperative monitoring of the course of anesthesia, the postanesthesia visit and inquiry of patient satisfaction. A prospective study of parameters in process and outcome quality in anesthesia].
This study is an investigation into the results of reporting on incidents during and after anaesthesia, to reveal any possible associations between intra-procedural and final outcome. The study contributes to the quality assurance project of the German Society of Anaesthesiology and Intensive Care (DGAI). We adjusted and tabulated our data for preoperative risk and for different methods of anaesthesia. This nation-wide DGAI project was launched to compare clinical institutions in accordance with German social legislation. ⋯ Quality parameters assessed by anaesthetists and patients are independent in respect to their frequency. For this purpose, anaesthesiological quality assurance must focus on both the anaesthetist and the patient. As clinical consequence, we suggest establishing an interdisciplinary post-anaesthesia service. Acceptance by, and collaboration between, the surgical disciplines are indispensable especially for a successful application of effective pain and antiemetic therapy.
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Comparative Study
A comparison of regional and general anesthesia in patients undergoing carotid endarterectomy.
The optimal anesthetic for use during carotid endarterectomy is controversial. Advocates of regional anesthesia suggest that it may reduce the incidence of perioperative complications in addition to decreasing operative time and hospital costs. To determine whether the anesthetic method correlated with the outcome of the operation, a retrospective review of 3975 carotid operations performed over a 32-year period was performed. ⋯ In a retrospective review of a large series of carotid operations, regional anesthesia was shown to be applicable to the vast majority of patients with good clinical outcome. Although the advantages over general anesthesia are perhaps small, the versatility and safety of the technique is sufficient reason for vascular surgeons to include it in their armamentarium of surgical skills. Considering that carotid endarterectomy is a procedure in which complication rates are exceedingly low, a rigidly controlled, prospective randomized trial may be required to accurately assess these differences.