Articles: general-anesthesia.
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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.
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Comparative Study
The dose-response relationship of mivacurium chloride in humans during nitrous oxide-fentanyl or nitrous oxide-enflurane anesthesia.
The dose-response relationships of mivacurium chloride during N2O/fentanyl or N2O/enflurane anesthesia were compared in 70 patients intraoperatively. Responses were defined in terms of percentage changes in the evoked twitch tension of the adductor pollicis muscle, and dose-response curves were constructed following probit transformation of the responses. End-tidal concentrations of enflurane during the were study were 0.9-1.2%. ⋯ Regression lines describing the relationship between the maximum depression of twitch tension (response) and the time interval between the injection of mivacurium and the return of twitch tension to 90% of the control value (duration) were constructed. The response-duration line for N2O/enflurane anesthesia was displaced significantly to the left of the line for N2O/fentanyl (P less than 0.05), indicating that enflurane anesthesia was associated with a prolongation of mivacurium-induced neuromuscular blockade. The neuromuscular blocking effect of mivacurium is both enhanced by and prolonged during N2O/enflurane compared with that during N2O/fentanyl anesthesia.
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Ann Fr Anesth Reanim · Jan 1989
Review[Continuous monitoring of mixed venous oxygen saturation in anesthesia in pulmonary surgery].
The multiplicity of potential causes of variations in mixed venous oxygen saturation (SvO2) during one lung ventilation (OLV), including a constant ventilation/perfusion mismatch, explains that it has been suggested as a routine monitoring procedure. To assess its usefulness, 12 adults undergoing OLV were monitored during surgery with an Oximetrix pulmonary catheter, placed on the side opposite to the surgical field under fluoroscopic control. Seventy two complete sets of haemodynamic measurements were obtained at 6 different times during surgery. ⋯ SvO2 had low Se and Sp for changes in other variables (CO: 76 +/- 7, 48 +/- 9; PaO2: 79 +/- 6, 59 +/- 9; VA: 54 +/- 7, 48 +/- 7 respectively). In this type of surgery, alterations in variables related to oxygen are probably balanced by haemodynamic changes. In fact, according to Fick's formula, SvO2 is almost completely determined by SaO2 and CO, when VO2 and haemoglobin remain stable.(ABSTRACT TRUNCATED AT 250 WORDS)