Articles: general-anesthesia.
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Neuromuscul. Disord. · Jan 1991
Case ReportsFatal rhabdomyolysis complicating general anaesthesia in a child with Becker muscular dystrophy.
A 6-yr-old boy who presented with brown urine due to myoglobinuria and who was otherwise virtually asymptomatic was diagnosed as having Becker muscular dystrophy on the basis of a greatly elevated creatine kinase, muscle biopsy, dystrophin analysis, and a deletion of exons 3-7 in the dystrophin gene. Fifteen months later, during a general anaesthetic for dental treatment, he had a cardiac arrest associated with acute rhabdomyolysis, hyperkalaemia and hypocalcaemia. He died 4 days later. This case is reported to highlight this rare but potentially fatal complication of anaesthesia in muscular dystrophy, and to discuss possible ways of preventing such a catastrophe.
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Nitrous oxide-oxygen sedation in dental treatment has been used to a limited extent at the dental schools in Oslo and Bergen since the middle of the 1970-ies. Anesthetists were responsible for the sedation until 1983. Since then two dentists at the pedodontic departments, one in Oslo and one in Bergen, have been licensed for the use of nitrous oxide. ⋯ The acceptance and cooperation from the patients were better with low concentrations of nitrous oxide than at higher levels. The side effects/complications were few and mild (4.1%). This study shows that nitrous oxide-oxygen sedation in dental treatment is excellent and safe for many patients that cannot be treated conventionally.
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Between 1982 and 1989 over 3000 patients were questioned about recall and dreaming after general anaesthesia for Caesarean section. Some 28 (0.9%) patients were able to recall something of their operation and 189 (6.1%) reported dreams. There was uniform adherence to a rigid anaesthetic protocol up to and including 1985, but a much publicized incident reported from the courtroom stimulated a relaxation of this regimen. ⋯ Recollections of surgery were confined to manipulations, noises and voices. None of our patients complained of pain at the time of interview, although one since has. The inadequacies of the initial protocol and an approach to informed consent are discussed.
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In a study of 280 patients (265 with cataract, 15 with strabismus), we investigated the ocular circulatory effects of 3 methods of anesthesia widely used in ophthalmic surgery, retrobulbar, peribulbar and general anesthesia. Retrobulbar anesthesia (RETRO) was performed with 2, 5 or 8 ml of a mixture (BLH-Mix) of bupivacaine 0.75%, lidocaine 2% and hyaluronidase; with 5 ml BLH-Mix and addition of adrenaline in a low (1:500,000) or a higher (1:200,000) concentration; with 5 ml bupivacaine 0.75% or lidocaine 2% or mepivacaine 2%; with 5 ml mepivacaine 2% and addition of 150 units hyaluronidase; or with 5 ml BLH-Mix plus adrenaline and additional oculopression. Peribulbar anesthesia (PERI) was performed with 8 ml BLH-Mix (5 ml inferotemporally/3 ml superonasally) or 10 ml BLH-Mix (8/4) injected outside the muscle cone. General anesthesia was performed using halothane (inspiratory concentration 0.5 vol%) and nitrous oxide (65 vol%); respiration was adjusted to produce slight hyperventilation (alveolar pCO2 33 mmHg) or forced hyperventilation (pCO2 20-25 mmHg), respectively. The following variables were measured; systolic ciliary perfusion and blood pressures (PPs,cil and Ps,cil, respectively) and ocular pulsation volume (PVoc) using oculo-oscillodynamography of Ulrich, and the intraocular pressure (IOD) using the Draeger handapplanation tonometer. ⋯ The anesthesia-induced lowering of both ocular perfusion and blood pressures as well as of the ocular pulsation volume, which is a measure of the pulsatile choroidal blood flow, can be interpreted as reflecting an inhibitory influence on ocular circulation. We suggest the following mechanisms to account for the changes during LA: elevation of IOP, adrenaline-induced retrobulbar vasoconstriction, LA-induced retrobulbar vasoconstriction (hypothetical), improved penetration of LA brought about by the orbital compression occurring during oculopression. The relative significance of the separate mechanisms differs, however, between the various LA types. The changes found during general anesthesia are attributable to the halothane-induced reduction of systemic blood pressure and cardiac stroke volume as well as to a relative hyperventilation-induced choroidal vasoconstriction. The results are relevant for ophthalmic surgery with respect to the prevention of complications and problems depending on pathologic or at least unphysiological changes in ocular circulation, e.g...
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Review Comparative Study
A comparison of general anesthesia and regional anesthesia as a risk factor for deep vein thrombosis following hip surgery: a critical review.
We evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. ⋯ All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.