Articles: general-anesthesia.
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A great deal of new information on alpha 2-adrenoceptor agonists has recently been accumulated in humans; alpha 2-agonists have several beneficial actions in clinical anesthesia including sedative, anxiolytic as well as analgesic effects, improved hemodynamic stability, and etc. In the first part of this review, we summarized the structure, signal transmission and basic pharmacology of alpha 2-adrenoceptor agonists (clonidine and dexamedetomidine), and evaluated their usefulness for premedication, and as anesthetic adjuvants as well as agents for stabilizing circulation in the clinical settings. In addition, we referred to practical problems associated with their use.
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This paper discusses the ways in which anesthetic agents can be used to investigate the role of awareness in learning and memory. It reviews research into learning during light, subclinical anesthesia, termed hypesthesia. ⋯ Overall, these findings are consistent with the hypothesis (e.g., Caseley-Rondi, 1996) that frontal lobe function is particularly sensitive to anesthetics. They raise theoretical and practical questions about the necessity of consciousness for learning and about interpretation of the evidence for learning during surgery under general anesthesia.
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We pointed out in the first of these two articles that the commonest cause of an anaesthetic disaster in young healthy patients is a loss of airway patency then a failure to intubate occurring unexpectedly in the absence of head or neck pathology. Upper airway obstruction is a very common complication of general anaesthesia and all anaesthetists must be trained in the management of this problem. Less obvious are the changes that can occur in the lower airways which can impair gas exchange by increasing ventilation-perfusion mismatch. This article is concerned with these pathophysiological changes that occur during general anaesthesia.
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Acta Anaesthesiol Scand · Oct 1996
ReviewAwareness in anaesthesia: incidence, consequences and prevention.
Awareness during anaesthesia is a state of consciousness that is revealed by explicit or implicit memory of intraoperative events. Although large clinical surveys indicate an incidence of explicit awareness of < 0.3% during anaesthesia for general surgery, this adverse effect should be a great concern, because patients may be permanently disabled by the experience of being awake during surgery. ⋯ The anaesthetic depth should be assessed by observation of movement responses, and consequently a minimum of muscle relaxants used. Because the anaesthetic depth can be controlled by determination of endtidal drug concentration, volatile inhaled anaesthesia may be associated with a lower frequency of awareness than other anaesthetic regimens.
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Pediatric neurology · Oct 1996
Review Case ReportsRhabdomyolysis and anesthesia: a report of two cases and review of the literature.
Rhabdomyolysis occurred in two apparently healthy boys aged 9.5 and 5.5 years after general anesthesia with suxamethonium. Mild hyperkalemia and renal failure were observed in the first patient, who was subsequently diagnosed with Becker dystrophy. In the second patient, the clinical presentation was not classic for malignant hyperthermia and a muscle biopsy failed to disclose any pathological finding. ⋯ Forty-nine (74%) cases were caused by an underlying, mostly unrecognized congenital muscle disease, and 14 (21%) cases were caused by malignant hyperthermia susceptibility. Hyperkalemia (23 patients), cardiac arrhythmias (38 patients), renal failure (4 patients), and death (11 patients) were the most serious complications of anesthesia-associated rhabdomyolysis. The neuromuscular blocking agent suxamethonium had been used in at least 43 of the patients reported in the literature.