Articles: general-anesthesia.
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Minor short-term depression of mental function is seen after anaesthesia and surgery. However, general anaesthesia does not seem to cause permanent damage or depress mental function beyond the first 2-4 postoperative days and no significant advantages of regional anaesthesia, as regards to cerebral function, are found after this period. ⋯ The risk of mental disturbance is increased in patients with psychiatric disease or presenile dementia and may be due to ongoing treatment with tricyclic antidepressant and neuroleptic drugs. Centrally acting cholinergic drugs, hypotension and hypoxia together with postoperative pain and sleep deprivation should be avoided.
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Review Randomized Controlled Trial Clinical Trial
[Intraoperative awareness in balanced anesthesia. A literature review based on a randomized double blind study using fentanyl, pentazocine and ketamine].
Since the first case report by Winter-bottom [106], the problem of intraoperative awareness or recall has received increasing attention from patients, anaesthesiologists and, more recently, even law courts [4, 20, 21, 78]. Our own interest in awareness derives from a study with the opiate agonist tramadol as a supplement to balanced anaesthesia, which revealed an unexpectedly high incidence of about 65% of patients who could recall intraoperative music [55]. It was the aim of the present randomized double-blind study to evaluate, under identical experimental conditions, what the incidence would be with other analgesic supplements to balanced anaesthesia (fentanyl, pentazocine and ketamine). ⋯ Recovery was fastest with F, followed by P, and slowest with K. Retrospective judgement of the quality of anaesthesia by the anaesthesiologist did not differ significantly between the treatment groups. Most (93%) of the patients were satisfied with their anaesthesia; 2 patients each who received P and K were dis
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Randomized Controlled Trial Clinical Trial
Fifty percent nitrous oxide does not increase the risk of venous air embolism in neurosurgical patients operated upon in the sitting position.
Although nitrous oxide (N2O) should theoretically increase the severity of venous air embolism (VAE), data confirming this hazard in clinical situations are not available. The effect of 50% N2O on the incidence and severity of VAE and on the emergence time from anesthesia was evaluated in 300 neurosurgical patients operated upon while in the sitting position. Of these, 110 patients underwent craniectomy for posterior fossa pathology and 190 patients underwent cervical spine surgery (CSS). ⋯ Emergence time was significantly longer in the craniectomy group than in the CSS group (5 vs. 1 min, respectively; P less than 0.001). Within the craniectomy group, the incidence of Doppler-detected VAE was significantly less in patients with previous surgery at the operative site (21%) compared to patients without previous surgery at the operative site (47%). Postoperatively, no complications could be related to the use of N2O or directly attributed to the occurrence of VAE.(ABSTRACT TRUNCATED AT 400 WORDS)