Articles: general-anesthesia.
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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[Treatment of malignant hyperthermia crisis during anesthesia].
Malignant hyperthermia (MH), triggered by anaesthesia, is a rare and potentially fatal condition. It requires immediate and specific treatment. This review focuses on anticipation and organisation of treatment. ⋯ A rational approach to the treatment of hyperkalaemia, circulatory and renal failure is discussed. After the crisis, dantrolene should be continued for a short time. Finally, the nonspecific signs which can give the earliest diagnosis possible of MH are discussed: an early diagnosis and early treatment with dantrolene are essential in reducing the mortality of malignant hyperthermia.
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Ann Fr Anesth Reanim · Jan 1989
Case Reports[A mistake in the filling of a vaporizer detected by an infrared analyser of halogenated anesthetic agents].
An anaesthetic pitfall related to an incorrectly filled vaporizer, without harmful effects on the patient, is reported. A halothane specific vaporizer has been accidentally partially filled with enflurane. The incident was suspected when the Datex Normac infrared analyser, calibrated for halothane, displayed an inspired concentration of 0.83% v/v, whereas the Dräger Vapor 19 vaporizer dial was set to deliver 0.4% v/v with a fresh gas flow of 2.7 l.min-1 to a circle system. ⋯ It may therefore be possible to detect a vaporizer filling error when the values "measured" by the analyser are not in concordance with those set on the vaporizer. Filling an enflurane vaporizer with halothane is more dangerous, as it results in a high halothane output with a Normac "enflurane" inspired concentration remaining very low. The indexed pin safety system remains the best means of avoiding wrong vaporizer filling.
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Randomized Controlled Trial Clinical Trial
Epidural vs general anaesthesia and leg blood flow in patients with occlusive atherosclerotic disease.
Total leg blood flow (plethysmography), skin blood flow (laser-Doppler flowmetry), and haemodynamic stability (MAP, HR, RPP) were studied in vascular (ABI less than 1.0; n = 31) and in non-vascular (ABI greater than 1.0; n = 24) surgical patients during epidural or fentanyl-supplemented general anaesthesia. During epidural anaesthesia significant increases in total leg blood flow were observed in vascular (from 1.9 +/- 0.2 to about 3 ml/100 ml tissue/min) as well as in non-vascular (from 2.5 +/- 0.6 to about 7 ml/100 ml tissue/min) patients and leg blood flow remained high in the postanaesthetic period. During general anaesthesia total leg blood did not increase, either in vascular or in non-vascular patients, and in the postanaesthetic period blood flow values even lower than the initial ones were observed. ⋯ In vascular patients no critical redistribution of blood flow within the limb was observed irrespective of the type of anaesthesia. Good haemodynamic stability could only be maintained in the epidural group. It is concluded that epidural anaesthesia seems to offer considerable advantages over general anaesthesia for high-risk vascular patients during arterial reconstructions since better haemodynamic stability and higher leg blood flow can be achieved.