Articles: general-anesthesia.
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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.
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Randomized Controlled Trial Clinical Trial
Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial.
To compare the effect of epidural vs general anesthesia on the incidence of long-term cognitive dysfunction after total knee replacement surgery in older adults. ⋯ The type of anesthesia, general or epidural, does not affect the magnitude or pattern of postoperative cognitive dysfunction or the incidence of major cardiovascular complications in older adults undergoing elective total knee replacement. This is the largest trial of the effects of general vs regional anesthesia on cerebral function reported to date, with more than 99% power to detect a clinically significant difference on any of the neuropsychological tests.
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Clinical TrialIntravenous ketorolac tromethamine does not worsen platelet function during knee arthroscopy under general anesthesia.
Ketorolac (KT) prolongs bleeding time and inhibits platelet aggregation and platelet thromboxane production in healthy, awake volunteers. However, platelet function may be accentuated during the stress of general anesthesia (GA) and surgery. The purpose of this study was to investigate platelet function changes during a standard GA technique and surgery, as well as after a single intraoperative dose of intravenous (i.v.) KT. ⋯ Platelet function appears to be accentuated during GA and surgery as evaluated by BT in the placebo group. Further, platelet function by BT, PA, and TEG was not inhibited after i.v. KT despite near complete abolition of TxB2 production.
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Multichannel laser Doppler flowmeters allow continuous, simultaneous measurement of perfusion in several organs. We measured microcirculatory blood flow in the kidney, liver, skin and skeletal muscle in 10 anaesthetized rats subjected to abdominal surgery and graded haemorrhage (withdrawal of 5% total blood volume every 10 min). Mean arterial blood pressure, heart rate and haemoglobin concentrations were also measured. ⋯ We conclude that laser Doppler flowmetry is useful for continuous measurement of microcirculatory blood flow in several organs simultaneously during haemorrhagic hypovolaemia. It showed that microcirculatory blood flow in skeletal muscle is particularly sensitive to lesser degrees of blood loss during anaesthesia. Hypovolaemia-induced slow wave flowmotion occurred only in skeletal muscle, which may be linked to fluid mobilization during haemorrhage.