Articles: general-anesthesia.
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Anaesth Intensive Care · Dec 1993
Randomized Controlled Trial Clinical TrialThe effects of providing preoperative statistical anaesthetic-risk information.
Are patients who are provided with details about anaesthesia risks on the eve of surgery better informed, and does the information increase their anxiety? Forty (ASA Class I or II) patients scheduled for surgery requiring general anaesthesia were randomly allocated to either a routine or a detailed information group. Levels of anxiety were assessed by the Spielberger State-Trait Anxiety Inventory. Actual knowledge of risks was assessed by a special visual analogue scale. ⋯ The detailed group, however, had gained more accurate knowledge of the likelihood of two rare complications, death (P < 0.001) and serious tooth damage (P < 0.05). Notwithstanding, there was no difference between the groups in anxiety. Thus, provision of detailed information about the risks of the complications of general anaesthesia did increase patients' knowledge but did not increase patients' levels of anxiety.
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Anaesth Intensive Care · Dec 1993
Comparative Study Clinical TrialTidal volume, lung hyperinflation and arterial oxygenation during general anaesthesia.
Impaired pulmonary oxygen (O2) exchange is common during general anaesthesia but there is no clinical unanimity as to methods of prevention or treatment. We studied 14 patients at risk for pulmonary dysfunction because of increased age, obesity, cigarette smoking, or chronic lung disease. Pulmonary O2 exchange was measured during four conditions of ventilation: awake spontaneous, conventional tidal volume (CVT, 7 ml.kg-1) or high tidal volume (HVT, 12 ml.kg-1) controlled ventilation, and five min after manual hyperinflation (HI) of the lungs. ⋯ Using a multivariate model to predict O2 exchange, obesity and type of surgery were significantly associated with worsening, while level of VT and inspiratory gas (N2O or N2) were not significant predictors. Thus patient and surgical factors were more important determinants of pulmonary gas exchange during anaesthesia than were tidal volume or inspiratory gas. Manual HI is a simple and effective manoeuvre to improve gas exchange.
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Anaesth Intensive Care · Dec 1993
Anaesthesia in rural Queensland: clinical experience with the Flying Obstetric and Gynaecology Service.
The Flying Obstetric and Gynaecology (FOG) service visits 27 outback towns scattered over approximately one million square kilometers of western Queensland. The role and workload of an anaesthetist attached to the FOG Service and a prospective audit of 760 consecutive anaesthetics over a ten-month period are reported. ⋯ This ensures that deficiencies in anaesthetic related areas are identified and appropriate action taken. The challenge to rural practitioners must be to provide a service, of at least an equivalent standard to that of their metropolitan counterparts.
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Case Reports
[Anesthetic management for cesarean section in two parturients with quintuplet gestation].
Two parturients with quintuplet pregnancy underwent urgent or elective cesarean section under general anesthesia at 30 and 29 week gestational ages respectively. Since multiple gestation pregnancy requires enough medical staffs and instruments for preterm newborn resuscitation, emergency cesarean delivery was avoided. ⋯ The anesthesia and postoperative course of two patients and their babies were uneventful. Thus, anesthetic considerations may include; 1) high risk pregnancy related with huge pregnant uterus, 2) preterm labor, 3) preparation of sufficient man-power and instruments, 4) to avoid uterine contraction before delivery for fetal oxygenation, and 5) the puerperal promotion of uterine contraction to decrease blood loss.
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The collective experience of 187 patients who suffered awareness during general anaesthesia is presented. This has been collated from letters solicited in September 1992 by a women's magazine widely distributed throughout Australia and New Zealand. ⋯ The findings show a disturbing symptomatology ranging over all modalities of sensation and of postoperative psychological and psychiatric disturbances. The letters also reveal that in most cases understanding of awareness and its proper management by medical personnel was poor or totally lacking.