Articles: general-anesthesia.
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We discontinued temporarily an infusion of propofol for surgical reasons in 20 patients undergoing incontinence surgery. The patients, who had not received neuromuscular blockers, were allowed to regain consciousness to a level enabling them to cough on command, open their eyes, and identify and verbally confirm a randomly assigned digit shown on paper. Thereafter, 5-14 min after discontinuation of the propofol infusion, anaesthesia was reinstituted. ⋯ Only 35% of patients were able to recall one or more of the stimuli presented during wakefulness or were even able to recall having been "awake", and there were very few differences in memory on the day after surgery compared with 1 h after anaesthesia. In comparison with corresponding stimuli given before anaesthesia, memory of material learned during wakefulness was significantly impaired (P < 0.0001). Thus patients temporarily capable of cognitive action during propofol anaesthesia may have no subsequent explicit recall of intraoperative events.
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Patients suffering from muscle disorders have an elevated anesthetic risk, i.e. to develop malignant hyperthermia or rhabdomyolysis. In addition serious cardial and pulmonal complications are imminent during anesthesia for surgery. ⋯ 83% of the patients showed pathologic ECG, 26% cardiac insufficiency in echocardiography, 31% pathologic X-rays of the thorax and 73% serious pulmonary restriction. Consequently avoiding of anesthetic agents with a high trigger potential for developing malignant hyperthermia (i.e. halothane or muscle relaxants type succinylcholine) prevented severest complications as malignant hyperthermia, rhabdomyolysis or cardiac arrest. Nevertheless other complications (i.e. arrhythmia, cardiac insufficiency) occurred due to the cardiac and pulmonary limitations more pronounced in the older patients of the spine surgery group.
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Although most anaesthetic textbooks cite dental injury as a complication of endotracheal intubation few studies have examined the extent and nature of the problem. Such damage however, formed the basis for one-third of all confirmed or potential anaesthetic claims notified to the Medical Protection Society between 1977 and 1986. This article seeks to explore the extent of the problem, outline predisposing factors, summarise current prophylactic measures and make recommendations to reduce the overall incidence. ⋯ Where he/she considers there to be a higher than average risk of dental damage occurring during intubation a more specialised examination should be conducted by a dental surgeon. It may, where appropriate, be possible for remedial dental treatment to be carried out and customised mouth guards to be constructed prior to the operation. Obviously such recommendations have certain financial implications and would have to be subject to controlled cost-benefit analysis before their widespread application.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Cricoid pressure: are two hands better than one?
One hundred and twenty patients were studied to compare the view of the larynx at laryngoscopy with one- or two-handed cricoid pressure applied. A blinded crossover technique was employed. When the grade of laryngeal view achieved with either type of cricoid pressure was compared using a 4-point scale there was no significant difference. ⋯ A two-handed technique has been advocated to improve intubation conditions when cricoid pressure is required. It has several disadvantages, its efficacy has not been proven and this study suggests it does not improve the view at laryngoscopy. Two-handed cricoid pressure should no longer be advocated unless an advantage over one-handed cricoid pressure can be shown.