Articles: general-anesthesia.
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Developments of anesthesia for cataract surgery emerging from literature published during the scanning period include new drugs for sedation before general anesthesia and some discussion about monitoring. A few articles report on both improvements in and complications of peribulbar and retrobulbar injections. ⋯ A tendency toward topical anesthesia emerged. Intraocular drug delivery was studied for toxicity both for cornea and for retina, in experimental and clinical settings.
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Review Comparative Study
[General or locoregional anesthesia: which to choose for a patient at risk?].
HIGH RISK SITUATIONS: The risk of surgery is higher in certain situations (subjects over 70 years of age, underlying disease states). Procedures lasting more than 3 hours or performed in emergency situations also increase the risk. The question is often raised as to which type of anesthesia, general or locoregional, is the most appropriate to lower the risk of complications in such situations. ⋯ It also eliminates the neuroendocrine response to surgical stress. MODEST EFFECT: Only a few precise parameters can differentiate risk between general and locoregional anesthesia. However, the type of anesthesia has little effect on overall morbidity or mortality, which depend more on the general status of the patient and the surgical procedure performed.
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J. Cardiothorac. Vasc. Anesth. · Dec 1998
ReviewPatient selection and anesthetic management for early extubation and hospital discharge: CABG.
Three model systems have been described that may facilitate an increase in the numbers of patients passing through the hospital within the resource allocation available: (1) early fast-track extubation, < 3 hours after surgery, (2) planned intensive care unit discharge < 18 hours, and (3) early hospital discharge < 5 days. Thus far, studies have not clearly identified patient group or risk demonstrating a need for prolonged intubation or delayed intensive care unit and hospital length of stay. It thus appears appropriate to suggest that all patients be considered suitable for early extubation, mobilization, and hospital discharge. ⋯ The ultrashort action of remifentanil facilitates the ability to plan and control the period of recovery of spontaneous ventilation and extubation while providing profound reduction of intraoperative stress responses and hemodynamic stability. Safe extubation requires that the patient be alert and cooperative, be hemodynamically stable and warm, is not bleeding, and has adequate respiratory function. Interventions with anti-inflammatory and hemostatic agents such as the serine protease inhibitor aprotinin or with corticosteroids can have a major impact on achieving the criteria needed to ensure rapid discharge from the intensive care unit.