Articles: general-anesthesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Does propofol have advantages over isoflurane for sufentanil supplemented anesthesia in children for strabismus surgery?].
The present study investigates the effectivity and the incidence of side effects of sufentanil-supplemented propofol versus isoflurane anaesthesia in children undergoing elective strabismus surgery. ⋯ Propofol as an induction agent of balanced anaesthesia fails to show advantages over thiopentone. During total intravenous anaesthesia propofol increases the risk of bradycardia especially in younger children. However, a significantly lower incidence of postoperative nausea and vomiting after TIVA with propofol and sufentanil, irrespective of N2O administration, may be an advantage over isoflurane anaesthesia in paediatric patients after strabismus surgery.
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Anesthesia and analgesia · Sep 1996
Prone positioning improves pulmonary function in obese patients during general anesthesia.
We investigated the effects of prone position on functional residual capacity (FRC), the mechanical properties (compliance and resistance) of the total respiratory system, lung and chest wall, and the gas exchange in 10 anesthetized and paralyzed obese (body mass index more than 30 kg/m2) patients, undergoing elective surgery. We used the esophageal balloon technique together with rapid airway occlusions during constant inspiratory flow to partition the mechanics of the respiratory system into its pulmonary and chest wall components. FRC was measured by the helium dilution technique. ⋯ Resistance of the total respiratory system, lung, and chest wall were not modified on turning the patients prone. The increase in FRC and lung compliance was paralleled by a significant (P < 0.01) improvement of PaO2 from supine to prone position (130 +/- 31 vs 181 +/- 28 mm Hg, P < 0.01), while PaCO2 was unchanged. We conclude that, in anesthetized and paralyzed obese subjects, the prone position improves pulmonary function, increasing FRC, lung compliance, and oxygenation.
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Regional anesthesia · Sep 1996
Randomized Controlled Trial Comparative Study Clinical TrialEffectiveness and safety of combined epidural and general anesthesia for laparoscopic cholecystectomy.
The aim of this study was to compare the efficacy and safety of two anesthesia techniques, combined epidural/general anesthesia (CEGA) versus total intravenous anesthesia (TIVA), for laparoscopic cholecystectomy. ⋯ The use of CEGA for laparoscopic cholecystectomy seems to be effective and safe and to offer some advantages as compared to TIVA alone. CEGA can control pain due to CO2-induced peritoneal irritation, providing excellent intra- and postoperative analgesia. CEGA does not require the use of intraoperative intravenous opioids and shortens recovery time, without increasing the incidence of side effects.
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Anaesthesia induction and deep anaesthesia may be accompanied by a considerable haemodynamic depression, especially in patients suffering from cardiovascular diseases. A decrease in cardiac index (CI) leads to a concomitant decrease in oxygen transport (DO2I). We examined whether these changes in haemodynamic performance and oxygenation can cause an oxygen debt and anaerobic metabolism. ⋯ We conclude that in patients suffering from a substantial cardiovascular disease systemic oxygenation is not impaired by considerable haemodynamic changes induced by general anaesthesia. This fact can be explained by the parallel decrease in oxygen demand, expressed by the decrease in VO2I.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 1996
Review[Mucociliary clearance function and medicamentous modification].
Mucociliary clearance represents a complex self-cleaning mechanism of the lung and is based on the functional unity of ciliated columnar cells and the special viscoelastic properties of the secretion produced in the tracheobronchial system. It has been known for a long time that intubation and mechanical ventilation can impair mucous transport and lead to morphological damage to the tracheobronchial mucosa. Recent studies made it clear, however, that mechanical ventilation during anaesthesia using an appropriate anaesthesiological technique has no deleterious effect on mucus transport in patients with healthy lungs. ⋯ In these patients a number of factors combine to form a formidable potential insult to the mucociliary transport mechanism. Numerous drugs can affect mucociliary transport. Beta-mimetics and theophylline, in particular, have a favourable effect on mucociliary transport, whereas the effect of mucolytic agents is controversial.