Articles: general-anesthesia.
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Randomized Controlled Trial Clinical Trial
Perioperative gastric aspiration increases postoperative nausea and vomiting in outpatients.
The efficacy of aspiration of gastric contents to reduce postoperative nausea and vomiting was investigated in a controlled randomized, double-blind study of 265 outpatients. Patients in the treated group had their stomachs aspirated with an orogastric tube. In the control group no tube was inserted. ⋯ It was also comparable in the recovery room and the day surgery unit. However, treated patients had a higher incidence of both nausea (26.5% vs 12.0%, P < 0.005) and vomiting (16.7% vs 6.8%, P < 0.02) after their discharge from the day surgery unit. We conclude that aspiration of gastric contents with an orogastric tube does not decrease postoperative nausea and vomiting in outpatients and may increase it after discharge of the patient.
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Laparoscopic surgery minimises postoperative morbidity. Patient benefits include reduction in postoperative pain, better cosmetic result and quicker return to normal activities. Hospital stay is shortened resulting in a reduction in overall medical cost. ⋯ An appraisal of the potential problems is essential for optimal anaesthetic care of patients undergoing laparoscopic surgery. Appropriate anaesthetic techniques and monitoring facilitate surgery and allow early detection and reduction of complications. The need for rapid recovery and short hospital stay impose additional demands on the anaesthetist for skillful practice.
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Comparative Study
An alternative method of increasing PCO2 using apnoea and continuous positive airway pressure.
We have examined the use of continuous positive airway pressure (CPAP) and apnoeic oxygenation for restoration of spontaneous breathing at the end of anaesthesia after controlled ventilation. We studied 45 adult patients without a history of acute or chronic respiratory disturbances. Anaesthesia was induced with thiopentone or propofol and maintained with nitrous oxide and enflurane in oxygen. ⋯ All patients were well oxygenated (PO2 mean 43.5 kPa, range 21-76 kPa) when spontaneous ventilation started. The pH was close to 7.28 in most cases (mean 7.28, range 7.21-7.32), and PCO2 varied in the range 6.6-9.9 kPa (mean 7.9 kPa). It is concluded that the method is safe with regard to oxygenation and acid-base balance.
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Ann Oto Rhinol Laryn · Apr 1993
Comparative StudyComparison of functional endoscopic sinus surgery under local and general anesthesia.
We present a retrospective comparison of intravenous sedation and general anesthesia techniques employed at New York University-Bellevue Medical Center for functional endoscopic sinus surgery. Some authors have stressed the use of local anesthesia with intravenous sedation in order to avoid complications and reduce blood loss. We have reviewed 232 patients who underwent 401 consecutive ethmoidectomies and maxillary antrostomies. ⋯ The rate of operative complications for local anesthesia was 8.7% per patient, with a 1.6% rate of major complications per side. General anesthesia carried an overall complication rate of 2.4% per patient, with no major complications. General anesthesia is a relatively safe and viable option for endoscopic sinus surgery that in selected cases may be preferable to local anesthesia.
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Acta Anaesthesiol Scand · Apr 1993
Randomized Controlled Trial Clinical TrialEffect of dihydroergotamine on leg blood flow during combined epidural and general anaesthesia and postoperative deep vein thrombosis after cholecystectomy.
The effects of dihydroergotamine (DHE) on the circulation of the leg during combined epidural and general anaesthesia were studied to determine if DHE would enhance leg blood flow and prevent postoperative deep vein thrombosis in a double-blind trial of 40 elderly female patients subjected to cholecystectomy. Central and big toe temperature, arterial blood pressure, heart rate, calf volume and arterial inflow of the leg by electrical impedance plethysmography and the venous outflow by Doppler method were measured. DHE 0.5 mg subcutaneously reduced the volume of the leg, i.e. increased the electrical impedance, probably due to venous vasoconstriction. ⋯ Intraoperative characteristics in patients with postoperative DVT were tachycardia (P < 0.001), enhanced need for etilefrine (P < 0.01) and a more rapid increase in big toe temperature (P < 0.05) after induction of epidural analgesia, compared with patients without DVT. Femoral vein flow velocity remained at the preinduction level, whereas pulsatile arterial inflow slightly increased. Together with a low basal impendance of the leg, the changes were indicative of a more intense vasodilatation, probably leading to stagnant flow and development of postoperative deep vein thrombosis.