Articles: general-anesthesia.
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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.
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Klinische Wochenschrift · Nov 1984
Randomized Controlled Trial Comparative Study Clinical TrialAdrenocortical suppression by a single induction dose of etomidate.
In a prospective controlled trial we studied the effect of a single induction dose of etomidate or thiopentone on the adrenocortical function in 29 patients undergoing elective surgery. During anesthesia and in the recovery period serum cortisol rose significantly in the thiopentone group only. ⋯ Moreover, plasma ACTH increased significantly more after etomidate than after thiopentone (p less than 0.02) indicating relative unresponsiveness of the adrenal cortex to stimulation by endogenous ACTH. We conclude that a single i.v. bolus of etomidate (0.26 mg/kg) leads to significant adrenal insufficiency in patients without preexisting endocrine abnormalities.
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In nine patients, with preoperative ICP monitoring, anaesthesia was induced with thiopentone 5 mg kg-1 given over 1 min, followed by pancuronium 0.1 mg kg-1. After manual hyperventilation with nitrous oxide and oxygen for 3 min they were given thiopentone 2.5 mg kg-1 over 30 s (phase 1); 30 s later laryngoscopy was performed and topical analgesia administered to the larynx. Endotracheal intubation was performed 1 min after spraying the cords (phase 2). ⋯ Although there was a significant decrease (P less than 0.05) in MAP at the end of the second dose of thiopentone, there were no other significant changes in ICP, MAP or PaCO2 throughout the study. In two patients there were transient decreases in cerebral perfusion pressure to less than 60 mm Hg. Although MAP increased in five of the patients during laryngoscopy and intubation, there was no increase in ICP, showing that the MAP was still within the autoregulatory limits.