Articles: general-anesthesia.
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Ankle inversion injuries are the most common injury in sport and yet treatment is controversial. One result is chronic ankle instability, an injury for which criteria for surgical intervention are unclear. ⋯ This suggests that a good history of chronic instability is more sensitive an indicator than conventional investigations. Stress views under anaesthesia may confirm the problem.
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Although the local anaesthetic prilocaine is less cardio- and neurotoxic than lidocaine, it bears the disadvantage of the formation of methaemoglobin by the metabolite o-toluidine. Prilocaine is often successfully used, especially for the blockade of the brachial plexus, but one problem of this technique is the failure rate of 3-10%, with the consequence that general anaesthesia after administration of prilocaine is frequently necessary. Methaemoglobin formation after prilocaine administration has been thoroughly investigated. ⋯ Three explanations seem plausible: (1) Thiopental blocks the hydroxylase of the endoplasmic reticulum, with the result that o-toluidine cannot be further metabolised, leading to higher o-toluidine and methaemoglobin levels. (2) Isoflurane improves the blood supply of the liver. This results in increased metabolism of prilocaine to o-toluidine. (3) The results were accidental. To clarify which of these explanations is correct, further investigation is necessary.
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Anesthesia and analgesia · Jun 1995
Comment Letter Comparative StudyCost comparison: a desflurane- versus a propofol-based general anesthetic technique.
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In the first part of this article (Vol 53(7) 1995, p.327), the physiology of vomiting and the factors known to influence postoperative nausea and vomiting (PONV) were summarised. In this second part the therapeutic options available to reduce the incidence of PONV are reviewed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1995
Review[Cardiovascular morbidity and anesthesia].
One of every four persons in the Western industrialised nations has cardiovascular disease. The perioperative setting in those patients is associated with the risk of myocardial ischaemia (PMI) and myocardial infarction, and also with the risk of perioperative stroke and dysfunction of the central nervous system (CNS). Perioperative cardiovascular morbidity represents a major healthcare challenge. ⋯ In fact, only one recent study has established that perioperative stroke is preventable with the use of an adenosine-regulating agent. Thus, it appears that it may be possible to prevent stroke, even though these results require confirmation. Because of the aging of our population, and the medical, financial and social impact of cardiovascular disease, the development of anti-ischaemic therapy, particularly in the surgical patient, will be a critical area of medical research for the next several decades.