Articles: general-anesthesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1996
[Postoperative mediastinal and subcutaneous emphysema after intubation narcosis].
The case of a 16-year old female is presented who underwent laparoscopy under general anaesthesia and uncomplicated endotracheal intubation. Four hours after uneventful anaesthesia and extubation the patient started vomiting and coughing. Subcutaneous tissue emphysema developed and pneumomediastinum was diagnosed on a chest roentgenogram. ⋯ A tracheal lesion during intubation is the most frequent and thus the most probable cause of air accumulation presenting as pneumomediastinum, pneumothorax or subcutaneous emphysema. As in the present case, increased airway pressure from vomiting or coughing even after a latent period may induce the phenomenon. Very occasional reports on spontaneous pneumomediastinum in young individuals must not detract the circumstances of endotracheal intubation from suspecting an iatrogenic lesion, confirming it by immediate endoscopy and thereupon deciding on conservative or surgical treatment.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Profile of the effect of succinylcholine after pre-curarization with atracurium, vecuronium or pancuronium].
The depolarizing muscle relaxant succinylcholine (SCh) may cause several side effects including muscle fasciculations and postoperative myalgia. These can be attenuated or even prevented by prior administration of a non-depolarizing muscle relaxant. A study was conducted to detect any difference between clinically established approaches concerning the successful prevention of muscular side effects and the influence on the time profile of SCh action. ⋯ The prolonged duration of the SCh effect after pancuronium is probably due to the known inhibition of cholinesterase by pancuronium. The short duration of action after Atracurium and Vecuronium can be explained by the competitive antagonism at the receptor causing an increased amount of unbound SCh. The duration of the SCh effect may be influenced according to clinical needs by the choice of the non-depolarizing muscle relaxant. The significantly reduced duration of complete neuromuscular block after Atracurium or Vecuronium as precurarizing agents may be advantageous in cases where a fast recovery of spontaneous breathing is essential. If a reduction of the SCh blockade has to be avoided, Pancuronium should be selected for prior administration.
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Clinical Trial Controlled Clinical Trial
Volumetric analysis of aeration in the lungs during general anaesthesia.
Spiral computed tomography (CT) allows volumetric analysis of formation of atelectasis and aeration of the lungs during anaesthesia. We studied 26 premedicated patients undergoing elective surgery allocated to group 1 (conscious, spontaneous breathing, investigating inspiration and expiration), group 2 (general anaesthesia with mechanical ventilation, investigating inspiration and expiration) or group 3 (general anaesthesia with mechanical ventilation, investigating changes over time). Using spiral CT, the lungs were studied either before or during general anaesthesia. ⋯ The mechanism of atelectasis appeared to be both gravitational forces and a diaphragm-related force that acts regionally in caudal lung regions. Mean atelectasis formation and poorly aerated regions comprised approximately 4% of the total lung volume between the diaphragm and carina, giving a mean value of 16-20% of the normal aerated lung tissue being either collapsed or poorly aerated. The vertical ventilation distribution was more even during anaesthesia than in the awake state.
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Cardioversion is a minor procedure requiring sedation and analgesia. However, it is often performed out-of-hours in remote sites by inexperienced anaesthetists. An understanding is required both of the pathophysiology underlying cardiac arrhythmias and of the technical side of defibrillation equipment, including electrical safety. ⋯ The anaesthetic agent chosen for patients undergoing cardioversion must provide analgesia and sedation, cause the least cardiovascular compromise possible and still enable rapid recovery. Propofol may be the closest anaesthetic agent to this ideal currently available, although careful titration of any agent chosen is also important. Cardioversion may be performed as an emergency, including in the pregnant patient, providing safe anaesthetic practice is followed.