Articles: general-anesthesia.
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The morbidity of transplantation is considerably decreased and the mortality of cadaver transplants from sepsis has been reduced to 5% or less as the result of excessive immunosuppression therapy and reduced infection. There is uniform agreement that renal transplantation has the best potential for restoring a patient with end-stage renal failure to his normal state of physical, mental, and psycho-social health. Both regional and general anesthesia have their drawbacks in kidney transplants. However, by combining the practice of safe anesthesia, improved surgical techniques, and better knowledge of the immunosuppressant drugs, there is near perfect control over the possibility of kidney rejection in kidney transplantation between identical twins.
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Nippon Sanka Fujinka Gakkai Zasshi · Apr 1983
[The maternal and fetal acid-base status during general or spinal anesthesia for elective cesarean section in the left tilt position].
Thirty one healthy parturients received spinal or general anesthesia for elective cesarean section. Maternal blood pressures, maternal and fetal acid-base values, induction to delivery intervals (I-DI) and Apgar scores were determined. On spinal anesthesia, acute hydration by 6% hydroxyethyl starch solution and intramuscular injection of ephedrine were enforced prior to the block and in the left tilt position (17 degrees) oxygen inhalation immediately after the block was begun (group OII: 16 cases). ⋯ A positive correlation between umbilical venous pH values and 1 or 5 minutes Apgar scores was confirmed in group OII, and a negative correlation between 1 minute Apgar scores and I-DI was noticed in group G. Fetal acid-base values were not correlated with I-DI in either group, and it was postulated that placental or fetal circulation was sufficiently maintained. Biochemical status and clinical conditions in mothers and their infants are very favorable in well-conducted general or spinal anesthesia for elective cesarean section.
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Following the introduction of muscle relaxants into anaesthesia there became recognised a state in which patients may be aware of their surroundings but unable to communicate their plight. This state of awareness is more likely to occur during light inhalational or total intravenous anaesthesia. Detection of awareness is difficult and several methods have been described. ⋯ Awareness can occur without patient recall and may be due to equipment failure or anaesthetic failure. The former is avoidable and the latter ought to be. Recommendations have been made regarding the use of premedicant drugs and volatile anaesthetic agents to reduce the incidence of awareness.