Articles: general-anesthesia.
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Twenty patients (23-76 yr) were studied with regard to lung tissue changes prior to and following induction of general anesthesia with muscular relaxation, and another four subjects were studied for a longer period awake. The transverse thoracic area and the structure of the lung tissue were determined by computerized tomography. No abnormalities in the lung tissue were noted before anesthesia. ⋯ The application of positive end-expiratory pressure of 10 cmH2O eliminated or reduced the densities. The four awake subjects showed no lung densities after 90 min in the supine position. It is suggested that these crest-shaped densities represent atelectases, which develop by compression of lung tissue rather than by resorption of gas.
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Anasth Intensivther Notfallmed · Apr 1985
Randomized Controlled Trial Comparative Study Clinical Trial[Circulatory effects of vecuronium as well as pancuronium under different conditions of anesthesia].
The cardiovascular effects of equipotent doses (1,25 X ED95) of vecuronium (70 micrograms/kg iv) and pancuronium (80 micrograms/kg iv) were studied in 16 patients scheduled for elective coronary artery bypass surgery during steady-state conditions of isoflurane (0,4-0,5 vol% end-tidal)-nitrous oxide anaesthesia. All patients were chronically treated with oral beta receptor-blocking agents. Vecuronium did not cause any significant cardiovascular changes whereas pancuronium produced increases in heart rate (13%), cardiac index (15%) and mean arterial pressure (4%) while systemic vascular resistance decreased (8%). ⋯ The administration of pancuronium (80 micrograms/kg) caused the greatest percentage increases in HR (20%), CI (22%), MAP (8%) and RPP (31%) in this group of patients. In contrast, patients (n = 8) anaesthetized with isoflurane-nitrous oxide who were not on preoperative beta-receptor blocker medication, demonstrated higher haemodynamic control values and less increases in HR (10%), CI (10%) and RPP (15%), MAP did not change. The clinical significance of these findings is discussed.
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General anaesthesia and many types of acute respiratory failure are accompanied by a decrease in functional residual capacity (FRC). This reduction promotes closure of dependent airways and alveolar collapse, thus impeding ventilation of these regions. Perfusion, on the other hand, is forced towards dependent regions by lowered pulmonary vascular pressure and increased alveolar pressure. ⋯ Application of general positive end-expiratory pressure (PEEP) increases FRC and may improve gas exchange but cannot restore V/Q to normal. Differential ventilation, with equal distribution of ventilation between the lungs, and the application of PEEP solely to the dependent lung (selective PEEP) with the patient in the lateral position, improve V/Q matching and gas exchange with less impedance of cardiac output and less danger of barotrauma. This ventilation technique has proved successful in short-term experiments and in a small number of patients treated over several days.
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Br J Clin Pharmacol · Mar 1985
Randomized Controlled Trial Clinical TrialThe evaluation of domperidone and metoclopramide as antiemetics in day care abortion patients.
A randomised double-blind investigation was undertaken to assess the value of domperidone and metoclopramide as prophylactic anti-emetics in unpremedicated patients undergoing general anaesthesia for therapeutic abortion on a day care basis. Sixty patients were divided into three groups, and received, at induction, one of three drugs intravenously. The incidences of postoperative nausea and vomiting were 35% in the group receiving normal saline as placebo, 30% in the group receiving 10 mg domperidone and 25% in the group receiving 10 mg metoclopramide; these were not statistically significantly different. Furthermore, there was no statistically significant difference in the incidence of postoperative nausea and vomiting as influenced by age, weight, length of gestation, anaesthetic time and a history of nausea and vomiting during the pregnancy.