Articles: general-anesthesia.
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Patients with subarachnoid hemorrhage from ruptured cerebral aneurysms frequently have systemic manifestations including hypovolemia and fluid and electrolyte disturbances in addition to neurologic symptoms. Anesthetic management therefore begins with proper preoperative evaluation and optimization. Anesthetic induction and maintenance are partly dependent on the patient's condition and seek to optimize cerebral perfusion, facilitate surgical exposure, and reduce the risk of intraoperative aneurysm rupture. Cerebroprotective strategy and adjunct monitors may be useful in some institutions.
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Gen Hosp Psychiatry · Sep 1998
ReviewAwareness during anesthesia and posttraumatic stress disorder.
It has been estimated that approximately 30,000 patients a year suffer awareness or consciousness during anesthesia. This paper reviews existing knowledge of the psychological impact and psychiatric sequelae of awareness during anesthesia. Literature on awareness and memory during anesthesia, traumatic memory, and posttraumatic stress disorder (PTSD) was reviewed using computer searches, books, and referenced articles. ⋯ Waking up during anesthesia, especially if the patient experienced pain, is a traumatic event which places the patient at risk for developing PTSD. Awareness-induced PTSD must be considered for patients who present for mental health treatment following surgery. The advantages of light anesthesia must be balanced against the risk of awareness-induced PTSD.
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Anesteziol Reanimatol · Sep 1998
Review Comparative Study[Antinociceptive components of general anesthesia and postoperative analgesia].
The philosophy of full-value antinociceptive protection of patients during and after surgical interventions is discussed. The author presents her viewpoint on the problem with due consideration for recent published reports. She advocates a prophylactic approach to attaining the antinociceptive protection (the so-called "preemptive analgesia"). ⋯ For preventing secondary (central) hyperalgesia and decreasing the intensity of postoperative painful syndrome, NMDA-receptor antagonist ketamine in microdoses is recommended before and during surgery. Afferent nociceptive flow can be decreased by local and regional anesthesia. Practical application of the preemptive analgesia principle improves the efficacy and safety of analgesia at different stages of surgical treatment, decreases total and local (at the level of operated tissues) consequences of surgical trauma, and decreases the probability of complications.
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Humidification during anesthesia is important to prevent adverse changes in the upper airways and possible pulmonary compromise. These changes may take place in less than 1 hour using dry nonhumidified anesthetic gases. Consequently, some method of humidification should be employed for all but the shortest of surgical procedures requiring general anesthesia. ⋯ It may be preferable to have a gas with a lower temperature and higher relative humidity because a warmer gas that is less saturated may result in increased desiccation from the upper airways. Humidification for neonatal and pediatric patients requires special consideration of resistance, work of breathing, and dead space. Further work is necessary with regard to the use of HMEs in this population of patients undergoing general anesthesia.