Articles: general-anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of epidural versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing radical prostatectomy.
Although preemptive analgesia has been shown to decrease postinjury pain in animals, studies in humans have provided controversial results. The authors studied whether surgical epidural anesthesia with local anesthetics could affect postoperative pain and analgesic demands, when compared with general anesthesia. ⋯ In patients undergoing lower abdominal surgery, the neuraxial blockade and surgical anesthesia achieved by epidural local anesthetics was associated with decreased postoperative analgesic demands. Lower postoperative analgesic requirements in the EA group, when compared with both the EG and GA groups, indicate that: (1) EA patients had less postoperative pain, and (2) an efficient intraoperative blockade of noxious afferent signals to the central nervous system is fundamental in reducing postoperative pain.
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For an exact evaluation of the risks of operations it is necessary to assess both co-existing and concomitant diseases before the performance of anaesthesia. The relatively low incidence of neurological and muscular diseases (0.02 to 0.7/1,000) and the low probability of an operation of a patient suffering from these diseases lead to higher anaesthesiological risks during the operation and the perioperative period. The anaesthetist is usually not always aware of all the special pathophysiological problems which have to be taken into consideration when these patients have to be anaesthetized. In order to reduce the risk of anaesthesia of these patients, we discuss the most important of these uncommon neurological diseases regarding their special anaesthesiological management.
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Anaesthesia for fetal distress is usually indicated for emergency caesarean section. General anaesthesia, which is the classical technique in these cases, remains the leading cause of anaesthesia-related maternal mortality. Difficult intubation and Mendelson's syndrome are mostly responsible for these fatalities. ⋯ For example, a "prophylactic" epidural instituted soon after the beginning of labor may be lifesaving in a patient with obvious signs of difficult intubation. A clear definition of safe standards of equipment and practices both to prevent Mendelson's syndrome or to cope with a failed intubation through a "failed intubation drill" is of paramount importance. Finally, a comprehensive communication between anesthetic and obstetrical teams is one of the most useful ways to allow a safer approach of the management of obstetric emergencies such as caesarean section for fetal distress.
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The two major neurological complications of subarachnoid haemorrhage (SAH) due to an intracranial aneurysm are rebleeding and delayed cerebral ischaemia related to cerebral vasospasm. The best way to prevent rebleeding is early surgery. Even when surgery is performed within the first 72 hours posthaemorrhage, the risk of cerebral ischaemia due to vasospasm is high. ⋯ To conclude, together with lumbar CSF drainage and transient clipping, the anaesthetic management of the patients should include: maintenance of the arterial blood pressure close to its preoperative level, maintenance of PaCO2 between 30 and 35 mmHg and of normovolaemia through replacement of fluid and blood losses. After completion of surgery, recovery from anaesthesia should be rapid to allow fast diagnosis of neurological complications. The monitoring of the status of consciousness is the key of the diagnosis of early postoperative complications.