Articles: general-anesthesia.
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Obstetrics and gynecology · Aug 1995
Randomized Controlled Trial Comparative Study Clinical TrialRandomized comparison of general and regional anesthesia for cesarean delivery in pregnancies complicated by severe preeclampsia.
To evaluate the maternal and fetal effects of three anesthetic methods used randomly in women with severe preeclampsia who required cesarean delivery. ⋯ General as well as regional anesthetic methods are equally acceptable for cesarean delivery in pregnancies complicated by severe preeclampsia if steps are taken to ensure a careful approach to either method.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1995
[Capnography for bronchoscopy with rigid technique using high frequency jet ventilation (HFJV)].
Rapid bronchoscopy in general anaesthesia still has its precise indications, where the high frequency jet ventilation technique offers several advantages. The monitoring of ventilation, however, has been rather unsatisfactory up to date. We therefore studied capnography in 60 bronchoscopies during HFJV (rate: 100/min; I:E = 0.33; driving pressure: 0.08-0.14 MPa) using a rigid bronchoscope with a distally located sampling port. Continuous capnograms were recorded. End-tidal partial pressures of carbon dioxide (petCO2), however, were obtained from 2-3 single breaths by intermittently reducing the jet-frequency to 10-12/min. After 6 min (MP1: whole group; n = 60) and 18 min of HFJV (MP2: n = 34 of this group) petCO2 values were regularly obtained and compared to pCO2 in synchronously drawn capillary blood samples (pcCO2). The jet driving pressure initially adjusted to body weight, however, was only corrected according to petCO2, aiming at 34 mmHg. ⋯ Capnography in rigid bronchoscopy during HFJV proved a clinically applicable addition to monitoring. Its routine use is strongly recommended in interventional bronchoscopy. The true petCO2 values obtained by intermittent single low frequency jet breathing permit estimates of gas exchange sufficiently exact for clinical purposes and for adjustment of the ventilator setting. Wave forms of the continuously recorded capnogram during HFJV are a warning of impeded ventilation or airway obstruction and, thus, of the danger of barotrauma or hypoventilation. Besides contributing to patient safety, this monitoring method might improve the acceptance of HFJV for bronchoscopy. Furthermore, it can also be applied to rigid bronchoscopy with common ventilation.
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Scoliosis surgery presents the anesthetist with specific clinical challenges. Since scoliosis is the most common problem for which patients of congenitally short stature present to the operating room, the preoperative evaluation of dwarfs is discussed here in the context of a patient with spondyloepiphyseal dysplasia congenita. ⋯ Consideration is given to cervical spine abnormalities, congenital absence of the odontoid process, pulmonary function abnormalities, and mucopolysaccharidosis (a syndrome which may compromise airway management). The intraoperative monitoring of somatosensory evoked potentials and their significance are also discussed.