Articles: general-anesthesia.
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Anaesthesiol Reanim · Jan 1995
Comparative Study[Interactions between renal and general hemodynamics in fentanyl, droperidol, ketamine, thiopental and in peridural anesthesia--animal studies].
The main focus of this paper is to show regulative interactions between cardiac index (CI) and renal blood flow (RBF) with various intravenous anaesthetics under steady state conditions. Several experimental series were carried out on dogs with the following anaesthetic doses (as given per hour and per kilogram body weight-h-1 x kg-1): fentanyl 50 micrograms, ketamine 4 and 10 mg, and thiopentone 10 and 20 mg. The basic anaesthesia used was halothane (0.7 vol.%) in N2O/O2 (ratio about 3:1), because renal function, renal autoregulation and responsiveness to renally effective drugs remain nearly unaltered by this anaesthetic procedure. ⋯ The effect of each anaesthetic drug on RBF has principally to be taken as regulative adaptation to altered circulatory conditions. Increasing plasma renin levels are mainly a compensatory reaction following a decline in arterial blood pressure due to anaesthesia induced sympathicolysis. With regard to renal function, the additional use of epidural anaesthesia (functional "denervation" of the kidney) can be recommended especially for highly invasive surgical procedures to antagonize reduction of RBF, which is often induced sympathetically by pain or by commonly used anaesthetic drugs.
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The Swiss Society of Anaesthesia and Resuscitation describes anesthesia as an activity of physicians, and a continuous presence of a medical anaesthesist is required. In small regional hospitals in the alpine region it is impossible to compete with big hospitals in the central area of Switzerland and there is no possibility to afford an anaesthesist for 365 days a year and 24 hours a day. ⋯ The education and the control of this person has to be performed by a medical anaesthesist. This is the only way in keeping the high quality of medical support in the peripheral region specially in the alpine part of our country.