Articles: general-anesthesia.
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Ann Fr Anesth Reanim · Jan 1985
Randomized Controlled Trial Clinical Trial[Determination of the dose-response curve for atracurium dibesylate in the anesthetized adult].
The mechanical response of the adductor pollicis to a 0.15 Hz stimulation of the ulnar nerve was studied in 35 unpremedicated adult patients (mean age 38 yr) under general anaesthesia using thiopentone, fentanyl and a N2O/O2 mixture under mechanical ventilation. PaCO2, pH, K, Ca, Mg plasma levels and temperature were in the normal range. Each patient received a single bolus of atracurium dibesylate: 0.10 mg . kg-1 (n = 11), 0.15 mg . kg-1 (n = 10), 0.20 mg . kg-1 (n = 11) or 0.30 mg . kg-1 (n = 4). ⋯ The 0.3 mg . kg-1 dose resulted in onset time of 4.7 +/- 1.3 min, duration of 39.9 +/- 3.7 min and a recovery index of 10.7 +/- 1.8 min. Thus atracurium dibesylate seemed to be an agent of intermediate potency. Onset time was approximately the same as that for other non-depolarizing neuromuscular blocking drugs, but duration of action and recovery index were quite shorter, except for vecuronium bromide.
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Comparative Study
Studies on the hormonal regulation of fuel metabolism in the human newborn infant undergoing anaesthesia and surgery.
Little is known of the endocrine and metabolic milieu in preterm and term neonates exposed to surgical stress. In order to define the effects of anaesthesia and surgery on the hormonal regulation of intermediary metabolism, the levels of plasma insulin, glucagon, adrenaline and noradrenaline were measured in addition to blood glucose, lactate, pyruvate, alanine, acetoacetate, hydroxybutyrate, glycerol and plasma-free fatty acids in 38 neonates (23 term, 15 preterm) undergoing surgery. Blood samples were drawn pre-operatively, at the end of surgery, and at 6, 12 and 24 h post-operatively. ⋯ Further analysis showed that total parenteral nutrition given just before surgery and thiopentone anaesthesia given during surgery significantly augmented the peri-operative hyperglycaemic response of term neonates. Thus, stress-related hormonal changes in preterm and term neonates may precipitate a catabolic state characterized by glycogenolysis, gluconeogenesis, lipolysis and mobilization of gluconeogenic substrates in the post-operative period. Prevention of these metabolic derangements by anaesthetic or hormonal manipulation may possibly help to improve the clinical outcome of neonates undergoing surgery.
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A case is presented of a patient who required anaesthesia for the removal of an inhaled silver tracheostomy tube. The anaesthetic problems are discussed. Regular inspection of silver tracheostomy tubes is recommended.
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The complications arising in association with the administration of general anaesthetics to 2658 inpatients for oral surgical procedures from 1978 to 1982 and to 999 outpatients from 1977 to 1981 are reported. In the two series of patients complications occurred with overall incidences of 17.2 and 25.1 per cent respectively. In the inpatient group the incidence of complications rose with age, with an increase in the surgical risk factor, and occurred with different frequencies according to the anaesthetic regime used. ⋯ Sedation methods in outpatients were almost free of complications. Most of the complications occurred during emergence from anaesthesia and in the early postoperative period. Nearly all patients receiving insufflation anaesthesia returned home on the same day but about three-quarters of those being intubated remained in hospital overnight.