Articles: general-anesthesia.
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We tested the hypothesis that different anesthetic techniques for elective cesarean section would be reflected in the pattern of breathing and its control after birth. The pattern of breathing, including tidal volume, total breath duration (TTOT), minute ventilation, inspiratory (TI) and expiratory times, TI/TTOT ratio, and mouth occlusion pressure, was measured in 27 infants delivered by elective cesarean section during maternal epidural (lidocaine-carbon dioxide-epinephrine, n = 19) or general anesthesia (66% oxygen in N2O and 0.5% halothane, n = 8) at 10, 60, and 90 min and 3-5 days of age. ⋯ In general, at any given age the values of the respiratory parameters measured and their variability were similar between the two groups of infants. These findings indicate that the pattern of breathing after birth is not different following epidural or general anesthesia, and on the basis of our measurements, both epidural or general anesthesia appeared equally suitable for elective cesarean section.
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Case Reports
Accidental severe hypercapnia during anaesthesia. Case reports and a review of some physiological effects.
Hypercapnia developed during anaesthesia in 2 patients owing to a nitrous oxide cylinder being filled with carbon dioxide. The aetiology and effects of gross hypercapnia during anaesthesia are reviewed.
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The intraoperative and postoperative effects of fentanyl and ketamine administered continuously by infusion were compared with those produced by conventional intermittent bolus administration in 100 patients. After a standardized induction with thiopental 4 mg/kg intravenously, patients received either fentanyl (50 micrograms boluses vs. 2 micrograms/ml infusion) or ketamine (25 mg boluses vs. 1 mg/ml infusion) as intravenous adjuvants to nitrous oxide, 70% in oxygen. With continuous infusion, the doses of fentanyl and ketamine required were decreased 45% and 43%, respectively. ⋯ However, excessive sedation was noted in 48% and 52% of patients in the fentanyl and ketamine bolus groups, respectively, compared with 4% and 8%, respectively, in the infusion groups. Discharge times were decreased by 29% and 13% in the fentanyl and ketamine infusion groups, respectively. The author concludes that continuous infusion fentanyl (0.1 micrograms . kg-1 . min-1) or ketamine (50 micrograms . kg-1 . min-1) significantly decreases the drug dosage requirement, improves intraoperative conditions, and decreases recovery time compared with the traditional intermittent bolus technique.