Articles: general-anesthesia.
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Cardiac arrests (CA) occurring during anaesthesia and recovery can be classified into three groups: CA not related to anaesthesia (NACA), CA related to anaesthesia (ACA), whether partially (PACA) or totally (TACA). In the French survey, NACAs were three times more frequent than ACAs. Nearly 25% of ACAs occurred at induction and consisted mainly in TACAs. ⋯ The anaesthesia machine and controlled ventilation can induce CA by hypoxic ventilation, overdose of anaesthetic vapour, excessive CO2 reinhalation, hypoventilation, disconnection, excessive pressure in airways. Cardiac hypothermia can be a cause of CA as well as a cause of unsuccessful CPR. Massive infusion of unwarmed fluids and IPPV with unheated gases generate a temperature gradient within the heart which may result in severe arrhythmias and CA.(ABSTRACT TRUNCATED AT 250 WORDS)
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Two patients with dystrophia myotonica presented for urgent Caesarean section. Their per- and postoperative courses illustrate the anaesthetic problems posed by this disease. ⋯ Choice of anaesthetic agent is discussed. Both had general anaesthetics; muscle relaxation was achieved with vecuronium.
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Ketamine has been employed as an anesthetic for 25 years. It is the only PCP-like dissociative anesthetic in clinical use. Favourable experience with ketamine in combat situations and at accidents, together with its ability to block the effect of the excitatory neurotransmitter glutamate on NMDA-receptor mediated neurotransmission, has attracted greater attention to this drug in recent years. ⋯ Recent investigations indicate that the analgesic and anesthetic effects as well as the "dissociative" phenomena seen after analgesic doses are due to PCP receptor mediated inhibition of excitatory amino acid transmission at NMDA synapses. The excitatory effect observed at higher doses, however, may be mediated by the haloperidol sensitive sigma-receptor. The enantiomers of ketamine (R- and S-ketamine) differ in pharmacological profile and may enable improvement of ketamine as a drug.
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Physiologic and pathologic changes due to ageing should be taken in account for the preoperative evaluation and peroperative management of geriatric patients. Pharmacokinetic changes ed to reduce the doses of intravenous agents by 50%. ⋯ Pharmacodynamic deleterious effects are limitative in the choice of some drugs. Cardiocirculatory and pulmonary functions need specific, if possible non invasive monitoring, during surgery, recovery and the early postoperative days.