Articles: general-anesthesia.
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Regional anesthesia · Jan 1995
Comparative Study Clinical TrialA retrospective comparison of interscalene block and general anesthesia for ambulatory surgery shoulder arthroscopy.
An increasing percentage of all surgery is performed in an ambulatory surgery setting. Concurrently, arthroscopy of the shoulder joint has allowed definitive repair of shoulder pathology to occur in this environment. This study was designed to ascertain whether interscalene block is reliable and efficient for use in same-day surgery compared with general anesthesia for shoulder arthroscopy. ⋯ Interscalene block should be considered as a viable alternative to general anesthesia for shoulder arthroscopy in ambulatory surgery patients.
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New justification for the use of regional anaesthesia, either alone or in combination with general anaesthesia, has been provided with reports of some unexpected influences on outcome. A reduction in the incidence of postoperative thrombotic episodes and vascular graft occlusion is strongly suggested in patients with generalized vascular disease. Application of a variety of drugs, including local anaesthetics, opioids and adrenergic agonists, in the region of the spinal cord reduces afferent input during surgery and also the metabolic stress response. ⋯ Premedication with opioid and other analgesics may also enhance this pre-emptive effect. New general anaesthetic and analgesic drugs are available that are more suited to these combined techniques. They have shorter duration of action so that plasma concentration can be rapidly adjusted to match a variable surgical stimulus.
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Cahiers d'anesthésiologie · Jan 1995
[Capnography in pediatric anesthesia: pitfalls and applications].
Expired CO2 analysis is an important area of anaesthetic monitoring. It ranges from ventilator connection to the estimation of alveolar dead space. ⋯ Confrontation between the technical specificities of CO2 monitors and the anatomical and physiological distinctive characteristics of the paediatric patient is mainly responsible for the interpretation difficulties encountered. Nevertheless capnography remains fundamental for paediatric ventilation monitoring.
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Comparative Study
Brief wakeful response to command indicates wakefulness with suppression of memory formation during surgical anesthesia.
In a previous study of patients emerging from anesthesia following surgery, we found that a brief wakeful response to command of an eye opening or single hand squeeze or count was not associated with memory formation, while the response of four hand squeezes or counts was associated with memory. We wanted to determine the anesthetic requirements for obtaining this brief wakeful response endpoint during surgery and to determine if memory occurred at this endpoint during surgical anesthesia. ⋯ A brief wakeful response to a command of opening the eyes or squeezing the hand was not associated with increased memory formation during surgery. A brief wakeful response to command was found during surgery when patients received fentanyl 4 micrograms/kg; but it was rarely found at fentanyl dosages of 2 micrograms/kg or less.