Articles: general-anesthesia.
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Anesthesia and analgesia · Jun 1990
Mass spectrometric measurements of oxygen uptake during epidural analgesia combined with general anesthesia.
Oxygen uptake was measured using a mass spectrometer system in 12 patients scheduled for abdominal surgery who intraoperatively were mechanically ventilated with 50% nitrous oxide and given continuous intravenous infusions of methohexital (3.5 mg.kg-1.h-1) plus repeated epidural injections of lidocaine. At the end of the surgical procedure, meperidine (0.7 mg/kg) was epidurally injected in six patients (group A). The other six patients (group B) received no epidural injections during the first 2 h after surgery. ⋯ Within the first two postoperative hours, clear-cut differences among the two groups arose. Patients in group A had smoother increases in oxygen uptake and core temperatures, greater cardiovascular stability as reflected by the rate-pressure product, and no visible shivering. We suggest that epidural meperidine given immediately at the end of a surgical procedure might be beneficial, especially, perhaps, in patients with impaired cardiac function.
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J Cardiothorac Anesth · Jun 1990
Dopamine counteracts hypertension during general anesthesia and hypotension during combined thoracic epidural anesthesia for abdominal aortic surgery.
The influence of the degree of sympathetic nervous system activation on the cardiovascular effects of dopamine was studied during abdominal aortic surgery in 13 patients. The arterial plasma norepinephrine concentration (NE) was used as an index of sympathetic nervous system activity. During anesthesia with nitrous oxide and fentanyl, 7 patients (group 1) had a NE above 700 pg/mL and an increased mean arterial pressure (MAP) compared with the preanesthetic level (150 +/- 6 v 117 +/- 10 mm Hg; p less than 0.01, mean +/- SEM). ⋯ This reduced MAP to 65 +/- 7 mm Hg (P less than 0.01) and 56 +/- 3 mm Hg (P less than 0.01), and NE to 441 +/- 76 (P less than 0.05) and 235 +/- 45 pg/mL (P less than 0.05) in groups 1 and 2, respectively. During TEA, dopamine increased MAP similarly in both groups, to 85 +/- 7 mm Hg (P less than 0.01) and 82 +/- 9 mm Hg (P less than 0.05), respectively. In conclusion, dopamine, at the same dosages, counteracted hypertension during general anesthesia and counteracted hypotension during general anesthesia combined with TEA.
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One hundred percent carbon dioxide was administered accidentally to a child aged 21 months during anaesthesia; this was caused by unauthorized filling of an oxygen cylinder with carbon dioxide. Cardiac arrest ensued, but was detected and treated promptly and no neurological deficit was detectable following recovery. The case demonstrates a typical preventable anaesthetic mishap and emphasizes the importance of monitoring oxygen supply and delivery.
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Neuropsychological and neurophysiological investigations indicate that a 30-40 Hz oscillatory brain mechanism is necessary for the adequate uptake and processing of elementary successive sensory events. An oscillatory component of that particular frequency range can be observed in the mid-latency auditory evoked potential (MLAEP). It is suppressed under non-specific anesthetic agents (agents not acting on specific structures of the brain or receptors). ⋯ By Fast-Fourier Transform-analysis corresponding power spectra were calculated to analyze energy portions of the AEP frequency components. In the awake state AEP showed an oscillatory component between 20- and 100-ms post-stimulus latency. Corresponding power spectra indicated a dominant 30-40 Hz frequency.(ABSTRACT TRUNCATED AT 250 WORDS)
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Swedish health care registries were used to identify women who had surgery during pregnancy and their offspring. Among the 2,252 infants born to women who had first trimester operations during 1973-1981, six had definite diagnoses of neural tube defects (expected number, 2.5). Scrutiny of the records showed that 572 operations occurred during gestational weeks 4-5, the period of neural tube formation, and that the mothers of five of the six infants with neural tube defects had an operation during that period (expected number of neural tube defects, 0.6) although one of the offspring probably had Meckel's syndrome. The relationship between neural tube defects and operation during pregnancy is discussed including the possibility that the association may be random.