Articles: general-anesthesia.
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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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We have investigated the effects of bolus administration of lignocaine 1.5 mg kg-1 i.v. on respiratory responses to airway irritation induced by instillation of distilled water into the trachea in 10 patients anaesthetized with enflurane (1.5% end-tidal). Before administration of lignocaine, airway irritation elicited not only the cough reflex, but also other respiratory reflexes such as expiration, apnoea and spasmodic panting. ⋯ Other reflex responses were suppressed completely; they recovered gradually with progressive decrease in plasma concentration of lignocaine. The apnoeic reflex was not eliminated at plasma lignocaine concentrations greater than 7.0 micrograms ml-1, whereas the expiration reflex, cough reflex and spasmodic panting were eliminated effectively by plasma concentrations of lignocaine greater than 3.5, 2.8 and 2.2 micrograms ml-1, respectively.
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Many children with malignant diseases who present with an anterior mediastinal mass must undergo general anesthesia for tissue diagnosis or tumor resection. One hundred sixty-three pediatric patients over a period of 6 yr were admitted to Memorial Sloan-Kettering Cancer Center with a diagnosis of anterior mediastinal mass. Forty four of these patients required surgery and their records were reviewed. ⋯ Four patients were unable to have their tracheas extubated at the conclusion of surgery and one patient required tracheal reintubation in the immediate postoperative period. These patients were treated with radiation therapy and chemotherapy after tissue for diagnosis had been obtained. The authors conclude that in the absence of life-threatening preoperative airway obstruction and severe clinical symptoms general anesthesia may be safely induced prior to radiation therapy.
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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.