Articles: general-anesthesia.
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Minerva anestesiologica · Dec 1999
Editorial Review Comparative StudyDo we need new supraglottic devices? Clinical appraisal of the cuffed oropharyngeal airway (COPA)
The laryngeal mask airway (LMA) has been widely studied for both conventional and nonconventional uses, while the literature on the cuffed oropharyngeal airway (COPA) is still limited. The purpose of this manuscript was to review the initial appraisal of efficacy, safety, effects on hemodynamics and respiratory function, induction agents and drug requirements of this new supraglottic device. ⋯ More extensive clinical evaluations should be advocated to better understand the risk/benefit ratio of this new supraglottic device; however, it may be concluded that in healthy adults receiving general anesthesia for short procedures the COPA allows for an effective and safe control of the patient's airway and ventilation.
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General anaesthesia has become, thanks to recently developed drugs, monitoring devices and delivery systems, a very well tolerated method of making the great surgical opportunities of the last few years available to all ages of patient. With a balanced and rational use of drug profiles, general anaesthesia allows even frail and very ill patients a margin of tolerability inconceivable just a few years ago. For the vast majority of patients, the risk from the general anaesthetic technique is so small it can be considered negligible. ⋯ The currently available drugs and their place in anaesthetic practice are also assessed. Recent developments in the area of total intravenous anaesthesia and monitoring for potential awareness using bispectral analysis suggest that this technique should now be included in the choice of anaesthetic. Recommendations are made on both the selection of the technique, and the appropriate agents for a given group of patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 1999
Review[Piracetam in anesthesia for prevention of postoperative delirium].
Delirium is a serious postoperative complication after general anaesthesia. The incidence is estimated to be about 10-15%. In the case of additional risk factors, such as old age, previously existing cerebral-vasculous and psychic deficiencies, and anaesthesia of long duration the incidence is much higher. ⋯ Especially patients with risk factors for postoperative delirium profited from prophylactic application of piracetam. The success of this medication can be explained by a protective influence of the substance on central neurons against hypoxia, ischemia and intoxication, all of which are discussed as possible causes for postoperative delirium. Next to the pathogenetic mechanisms of postoperative delirium, the mode of action of piracetam is shown in a review and a summary of references on the clinical use in anaesthesia is given.
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The additive properties of general and regional anesthetic techniques are brought together in combined anesthesia to minimise side effects of the individual techniques. Despite a wide experience with both used as single anesthetic techniques, no definite recommendations regarding indications, general contraindications and procedure exist for their combination. Beneficial effects on haemodynamics, respiratory function, intestinal motility and postoperative stress response have been demonstrated for a combination of general anesthesia and thoracic epidural anesthesia (TEA). ⋯ Nevertheless, until now no reduction of perioperative morbidity and mortality has been demonstrated. Since the combination of two anesthesia techniques theoretically increases the rate of complication, the expected benefit for the patient must predominate. To estimate the risks and benefits of combined anesthesia, the anesthesiologist must be familiar with each single method, as well as with the synergistic effects of both techniques in order to evaluate the individual indication.