Articles: general-anesthesia.
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Randomized Controlled Trial Clinical Trial
Inspired oxygen concentration during general anaesthesia for caesarean section.
The effects on maternal oxygen saturation, foetal wellbeing and umbilical blood gases were compared when parturients received either 30 or 50% oxygen prior to delivery by Caesarean section under general anaesthesia. Maternal arterial oxygen saturation was significantly increased in the group receiving 50% oxygen. There was no difference between the two groups in terms of Apgar score minus colour, time to sustained respiration or umbilical cord blood gas estimations. The use of 30% inspired oxygen during uncomplicated Caesarean section is advocated.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of perioperative mental function after general anaesthesia and spinal anaesthesia with intravenous sedation.
This study compared the postoperative mental function in 44 elderly patients following general anaesthesia (GA) or spinal anaesthesia (SA) with sedation for transurethral resection of prostate. The Mini-Mental State (MMS) was done preoperatively and postoperatively at six hours, one day, three days, five days and one month. The geriatric mental status examination was performed preoperatively and one month after the anaesthetic. ⋯ In the GA group, the significant decrease in MMS score occurred at 6 h postoperatively (P less than 0.002) whereas in the SA group with sedation, MMS score also decreased significantly at 6 h (P less than 0.005). In conclusion, there was no significant difference in perioperative mental function between the general and spinal anaesthetic groups when supplemental IV sedation was given. In both groups, perioperative mental function decreased significantly at 6 h postoperatively.
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Case Reports
Complications during anaesthesia in patients with Duchenne's muscular dystrophy (a retrospective study)
The purpose of this retrospective study was to estimate the frequency and severity of anaesthetic complications in patients with Duchenne's muscular dystrophy (DMD). Forty-four boys with DMD were exposed to anaesthesia and surgery 84 times during a period of 22 years (1965-86). The procedures took place at 15 different hospitals. ⋯ Three out of the eight patients with severe complications occurred 1.5, 2.5 and 4 years before the neuromuscular disease was diagnosed. Thus an unusual course of anaesthesia in male children calls for further investigation. Although it has been stated before that succinylcholine is contraindicated in patients with Duchenne's muscular dystrophy, the drug continues to be used.
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The need to incorporate alarms in monitoring systems is related to the growing complexity of monitoring and the large number of variables. For sophisticated alarms, information about the inputs to the patient is of importance; for example, clinical interventions such as drug administration and ventilation readjustment need to be known to the monitoring system. Alarms are triggered by signals or signal features that exceed thresholds. ⋯ Approaches to determine such levels automatically are discussed in this article. Most promising seems the multiple signal approach using an expert system. It seems reasonable to expect that information concerning alarm limits, needed for the operation of knowledge-based alarm systems, may come from integrated departmental data bases.
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Comparative Study
The auditory evoked response as an indicator of awareness.
The latency of the early cortical wave Nb of the auditory evoked response (AER) was compared with responses to Tunstall's isolated forearm test, while the concentration of nitrous oxide was progressively reduced during light anaesthesia in seven patients. A threshold Nb latency of 44.5 ms was chosen to discriminate between an early cortical AER containing three waves and that with two waves of longer latency. ⋯ The addition of a volatile anaesthetic abolished any response, and increased Nb latency to more than 44.5 ms. The three wave AER pattern, therefore, is associated with a depth of anaesthesia at which awareness occurs.