Articles: general-anesthesia.
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During carotid endarterectomy (CEA), phenylephrine infusions are commonly used to induce hypertension during carotid clamping in an attempt to increase collateral cerebral blood flow and prevent cerebral ischemia. Although this practice appears to increase the incidence of intraoperative myocardial ischemia during CEA when general anesthesia is employed, whether the limited use of phenylephrine infusions in specific instances of cerebral ischemia, as shown on an electro-encephalogram, results in low perioperative rates of both myocardial infarction (MI) and cerebral infarction remains unclear. We studied 171 CEAs done under general anesthesia performed with selective shunting based on the identification of cerebral ischemia by a two-channel computerized electroencephalographic monitor. ⋯ Two non-Q wave MIs (1.2%) occurred, both nonfatal. There were two cerebral infarctions (1.2%) and three deaths not related to MI (1.8%). Based on these findings, in order to decrease the incidence of both MI and cerebral infarction after general anesthesia for CEA, we recommend the restrictive use of phenylephrine-induced hypertension for specific instances of slowly or poorly reversible cerebral ischemia, as shown on the electroencephalogram.
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We studied the protective effect of prostaglandin E1 (PGE1)-induced hypotensive anesthesia on gastric mucosa in 30 elective surgical patients. Three groups, each composed of 10 patients, received PGE1, nitroglycerin or none during general anesthesia. ⋯ In the PGE1 group the viscosity and pH increased significantly and rapidly (P less than 0.05) as compared with the other groups. This suggests that PGE1 offers prophylactic effect against postoperative acute gastric mucosal lesion (AGML).
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Rev Esp Anestesiol Reanim · May 1992
Historical Article[The introduction of chloroform anesthesia in Madrid. Notes for studying its history].
Until present, the introduction of chloroform anesthesia in Madrid has not been specifically studied by any author. Therefore, knowledge of the events related to this happening is lacking. We have studied this chapter of our history by analyzing primary documents and articles published at the daily press, political press, and scientific journals of Madrid during 1847 to 1848. ⋯ Based on the present bibliographic material we could establish a chronologic report of all surgical interventions using chloroform that were performed in Madrid. We conclude that albeit surgeons in Madrid were not the first to use chloroform in Spain, they were, however, the ones who most extensively used it. Their contribution was of relevance in the settlement of the new anesthetic agent in Spain.
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Comparative Study
Frequency and severity of desaturation events during general anesthesia in children with and without upper respiratory infections.
To determine whether anesthesia in the presence of a mild upper respiratory infection (URI) was associated with episodes of desaturation or reactive airway problems. ⋯ Children with a mild URI have an increased frequency of minor desaturation episodes, and intubated patients with a URI have an increased frequency of bronchospasm. It appears that children with a mild URI may be safely anesthetized, since the problems encountered are generally easily treated and without long-term sequelae.