Articles: general-anesthesia.
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We evaluated the significance of patient's position in the measurement of gastric contents at the induction of anesthesia (n = 18). After the induction of general anesthesia with tracheal intubation, a nasogastric tube (16F) was inserted into the stomach. ⋯ The existence of the gastric content which can not be aspirated with supine position was confirmed. We conclude that it is necessary to place the patient on bilateral decubitus positions besides supine to evaluate the volume of the gastric content correctly.
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Anesthesia and analgesia · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of tracheal extubation in patients deeply anesthetized with desflurane or isoflurane.
A randomized, single-blind study design was used to compare desflurane with isoflurane in 31 adults undergoing intraocular surgery to determine whether the lower blood:gas partition coefficient of desflurane would result in a more rapid emergence after endotracheal extubation of deeply anesthetized patients. A standardized general anesthetic technique was used, consisting of sufentanil, 0.25 microgram/kg, and propofol, 1.5 mg/kg, followed by either isoflurane (n = 15) or desflurane (n = 16) in an air/oxygen mixture. After the operation and reversal of residual neuromuscular block, spontaneous ventilation was reestablished and the patients' tracheas were extubated at equianesthetic concentrations of desflurane and isoflurane (i.e., approximately 1.4 times the minimum alveolar anesthetic concentration [MAC]). ⋯ Use of desflurane (versus isoflurane) was not associated with an increased incidence of coughing or airway irritation during the emergence period. However, use of desflurane did not significantly reduce the duration of the postanesthesia care unit (PACU) stay or alter later recovery events compared to isoflurane. In conclusion, the more rapid emergence would favor the use of desflurane when tracheal extubation during deep anesthesia is required.
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Twelve cases of post-anaesthetic pulmonary oedema (PO) secondary to upper airway obstruction (UAO) are reported. All were adult male patients undergoing uneventful elective surgical procedure under general anaesthesia. Post-anaesthetic laryngospasm was the single most important factor for the upper airway obstruction (UAO) in 5 (41.6%) patients. ⋯ Early recognition, maintenance of patent airway and adequate oxygenation via face mask or endotracheal tube with mechanical ventilation resolved the syndrome within 6-36 hours in all of these patients. Invasive haemodynamic monitoring or aggressive drug therapy were not applied in any of the patients. A heightened awareness among anaesthesiologists of the varied causes of post-anaesthetic UAO leading to PO may help reduce the occurrence and facilitate early management of the potential complications.
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Conscious awareness is an infrequent complication of general anesthesia. All methods of anesthesia have been implicated, and no method guarantees amnesia. This article examines implicit and explicit memory and discusses factors associated with awareness. ⋯ Strategies to block threatening auditory stimuli include use of earphones, music tapes, white noise, reassuring statements, or positive suggestion. Behavioral anesthesia decreases patient stress to enhance recovery. Evidence of patient benefit resulting from therapeutic suggestion is inconclusive.