Articles: general-anesthesia.
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Recent therapeutic advances in inotropic drugs and vasipressors uses allow a reappraisal of their indications during the perioperative period. Non-catecholamines vasopressors, ephedrine and phenylephrine, are particularly suitable for treatment of abrupt peroperative arterial hypotensions as observed during induction of general and medullar anesthesias. Cardiac arrest, peroperative anaphylactoid and toxic accidents are treated with epinephrine. ⋯ Inodilators (enoximone, amrinone and milrinone) ans nex dopaminergic compound (dopexamine) are powerful vasodilators agents to be introduced with care when association of amines and current vasodilators have failed. Finally, arterial pressure has to be maintained with norepinephrine after dopamine failure. Epinephrine remains last chance.
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This investigation evaluated the hemodynamic effects of orally administered dexmedetomidine in chronically instrumented dogs in the conscious state, during enflurane anesthesia, and after emergence. Four experimental groups (n = 9 each) were completed. In groups 1 and 2, dexmedetomidine (10 or 20 micrograms/kg, respectively) was administered orally, and hemodynamics, arterial blood gas tensions, and plasma norepinephrine concentrations were monitored for 6 h. ⋯ Peak effects occurred within 30 min and lasted approximately 3 h. No reduction in coronary blood flow velocity, decrease in regional contractile function, or respiratory depression was observed. Administration of dexmedetomidine before enflurane anesthesia also was associated with a reduction in heart rate and rate-pressure product, and dexmedetomidine prevented the increase in heart rate (146 +/- 9 vs. 60 +/- 7 beats per min) and arterial pressure (117 +/- 7 vs. 98 +/- 7 mmHg) during emergence from anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Akush Ginekol (Mosk) · Jan 1991
Comparative Study[Changes in various indicators of secondary hemostasis in physiological labor and cesarean section in relation to the type of general anesthesia].
Combined ketamine++ anesthesia and combined neuroleptic anesthesia were examined for impact in cesarean section. This revealed that the former anesthesia caused moderate hypercoagulative changes in the hemostatic system and a drastic increase in fibrinolysis at the end of the operative intervention. Early in the postoperative period, general combined neuroleptic anesthesia induced a profound hypercoagulation and inhibited fibrinolysis that preserved, which might result in thrombophilic events.
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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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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...