Articles: general-anesthesia.
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Anasth Intensivther Notfallmed · Feb 1989
[The use of pulse oximetry in detecting disorders of the arterial oxygen status in the immediate postoperative phase exemplified by combination anesthesia with isoflurane].
Adequate respiratory monitoring should immediately indicate deteriorations of arterial oxygen status, e.g. hypoxia (paO2-decrease [mmHg]), hypoxaemia (caO2-decrease [ml/dl]) and hypoxygenation (saO2-decrease [%]). These alterations have been detected in the early postanaesthetic period only by the classical clinical criterias cyanosis and tachycardia. Therefore, O2-application often is recommended for the first 10 min postoperatively. ⋯ With respect to the limitations of the method (measurement of arterial O2-saturation in peripheral circulation using pulse wave as an inflow indicator of arterial blood into the capillary bed; increased Hb-derivative concentrations, e.g. COHb), pulse oximetry for estimation of partial O2-saturation (psO2) seems to be the respiratory monitoring of choice in the early postoperative period. In that sense it is superior to pO2 but inferior to saO2 and caO2.
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Anasth Intensivther Notfallmed · Feb 1989
[Noninvasive monitoring of gas exchange: methodologic prerequisites and clinical use].
The noninvasive determination of the respiratory gas exchange (measurement of oxygen uptake and carbon dioxide delivery) permits the calculation of cardiac output by Fick principle and of the actual energy requirement of the patient (indirect calorimetry). A system is presented for the continuous measurement of oxygen uptake and carbon dioxide delivery, that bases on simple components, which are available on most intensive care units. ⋯ The results reveal, that 4.4 hours after ECC the metabolic rate is close to the calculated basic metabolic rate. They demonstrate the importance of indirect calorimetry as a future bedside monitoring routine.
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Apneic, anesthetized patients frequently develop airway obstruction or may be disconnected from ventilatory support. The rate of PaCO2 rise is usually assumed to be equal to that of anesthetized humans who are receiving apneic oxygenation. Apneic oxygenation may eliminate CO2 because it requires a continuous O2 flow. ⋯ Piecewise linear approximation yielded a PaCO2 increase of 12 mmHg during the first minute of apnea, and 3.4 mmHg/minute thereafter. These values should be employed when estimating the duration of apnea from PaCO2 change for anesthetized patients who lack ventilatory support. In addition, it appears that the flows of O2 that most earlier investigators used when delivering apneic oxygenation probably did not eliminate significant CO2 quantities.
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Children are ideal patients for outpatient surgery. Thorough preoperative medical evaluation and selection of appropriate surgical and anesthetic procedures allow most pediatric surgery to be performed safely on an outpatient basis. ⋯ Good anesthetic management consists of selecting anesthetic agents and techniques to promote safety, minimize complications, reduce postoperative nausea, vomiting and pain, and facilitate recovery and discharge. Most importantly, the outpatient setting permits minimal disruption of a child's life and provides an opportunity for the pediatric patient and family to have a positive health-care experience while receiving necessary surgical care.
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Acta Chir Scand Suppl · Jan 1989
Comparative StudyBeneficial effects on intraoperative and postoperative blood loss in total hip replacement when performed under lumbar epidural anesthesia. An explanatory study.
The effects of continuous lumbar epidural anesthesia and two types of general anesthesia on blood loss and hemodynamics during and after total hip replacement were compared in three groups of patients. Fourteen patients received local anesthetics via continuous lumbar epidural administration; 10 patients received inhalational anesthetics and breathed spontaneously after endotracheal intubation; and 14 received artificial ventilation after intubation and intermittent intravenous (i.v.) injections of pancuronium and fentanyl. The results documented that both intraoperative and postoperative blood losses were significantly reduced in patients subjected to total hip replacement under lumbar epidural anesthesia as compared with the patients receiving the two general anesthetic techniques. ⋯ Postoperatively, the hemodynamics of the general anesthesia groups were similar, and no differences in blood loss occurred. Continuous' epidural anesthesia can be viewed as a tool to achieve hypotensive anesthesia--notably on the venous side--for the purpose of minimizing blood loss. The reduction in blood loss associated with lumbar epidural anesthesia is beneficial in decreasing the hazard and cost of blood transfusion.