Articles: general-anesthesia.
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Anesthesia and analgesia · Jun 1988
Mivacurium chloride (BW B1090U)-induced neuromuscular blockade during nitrous oxide-isoflurane and nitrous oxide-narcotic anesthesia in adult surgical patients.
The neuromuscular and cardiovascular effects of mivacurium were studied in 90 adult patients during nitrous oxide-oxygen-isoflurane (n = 45, ISO group) and nitrous oxide-oxygen-narcotic (n = 45, BAL group) anesthesia. Neuromuscular blockade was measured using electromyographic activity of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. To estimate dose-response relations, three subgroups of nine patients in the ISO group received mivacurium doses of 0.025, 0.03, and 0.04 mg/kg, respectively. ⋯ Recovery indexes were measured in 26 patients who received ED95 or greater doses of mivacurium in either the ISO or BAL groups. The recovery index was shorter in the BAL group (5.5 +/- 1.6 minutes [n = 10]), than in the ISO group (7.4 +/- 3.0 minutes [n = 16]). The addition of isoflurane (0.5-0.75% end-tidal concentration) to nitrous oxide-narcotic anesthesia augments the degree of neuromuscular blockade from a given dose of mivacurium and also prolongs the recovery index.
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Successful anaesthetic management of two patients with severe epidermolysis bullosa dystrophica was accomplished with the use of ketamine-diazepam dissociative anaesthesia in one and brachial plexus block in the other. The classification and pathology of epidermolysis bullosa is considered, and the problems associated with anaesthesia in patients with this disease are discussed.
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Stroke volume and cardiac output (CO) can be determined noninvasively by means of the pulsed Doppler technique to measure blood flow velocities in specified regions of the heart or neighboring great vessels along with 2D-echocardiographic imaging to measure the diameter of vessels or valve orifices. Disadvantages of the transthoracic approach, such as precordial inaccessibility and instability of the probe position, have prevented the continuous application of pulsed Doppler echocardiography during surgery. Recently, we presented a new technique using the transesophageal approach with combined pulsed Doppler measurements and 2D-echocardiographic imaging. ⋯ Use of halothane in 8 further patients resulted in a 21.0 +/- 5.9% and 37.3 +/- 11.7% decrease of TDE-CO at 1.0 MAC and 1.5 MAC, respectively. Transesophageal images adequate to determine the cross-sectional area of the pulmonary artery could be obtained in 16 of 27 (59.3%) patients. CO determined by the TDE pulmonary flow method (28 measurements in 16 patients) correlated with the TD-CO, with an r value of 0.91 and SEE 0.49 l/min.(ABSTRACT TRUNCATED AT 400 WORDS)
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The oxygen saturations of 152 children were studied for the first 30 minutes following general anaesthesia with a pulse oximeter. Thirty-six patients (24%) recorded oxygen saturations of less than 90% while breathing room air and in all cases this occurred during the first ten minutes. ⋯ There was no significant correlation with age, weight, procedure, time to wakening, or use of opiates. Clinical signs correlated poorly with hypoxaemia and it is recommended that all children should receive supplementary oxygen during transport to recovery wards and for at least the first ten minutes in recovery following general anaesthesia.
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An anaesthetic technique suitable for training in fibreoptic intubation is described. It uses a capped oropharyngeal airway which leaves the nose free for fibreoptic intubation and allows the airway to be maintained and ventilation to be controlled if necessary. An assessment is made of the technique after 50 fibreoptic intubations with the Olympus LF-1 fibrescope. There were no failed intubations and no serious complications.