Articles: general-anesthesia.
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A case of malignant hyperthermia in a young girl with vesicoureteral reflux and multiple congenital abnormalities is discussed. Malignant hyperthermia is a relatively newly defined problem that is associated with anesthesia. It is being recognized with increasing frequency, particularly in children with multiple musculoskeletal anomalies. ⋯ It is a drug-induced syndrome of hypermetabolism that may represent an inborn error of metabolism. Recognition, prophylaxis and crisis management are reviewed, and the use of dantrolene sodium in the care of patients with malignant hyperthermia is discussed. Because recognition of malignant hyperthermia is an important concern for the practicing urologist, the principles of identifying the patient at risk, as well as managing the crisis, should be familiar to the clinician.
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During a three year period, pediatric patients 4 to 16 years old were post-operatively screened for anaesthesia-induced myoglobinuria. All investigated cases had general anaesthesia and received succinylcholine prior to intubation. Anaesthetics were predominantly performed for tonsillectomies and/or adenoidectomies. ⋯ Anaesthesia-induced myoglobinuria occurs more often than previously presented. This abnormal reaction to succinylcholine is not harmless in all cases. The possible genetic influence on total CPK and its isoenzymes is discussed.
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Anasth Intensivther Notfallmed · Feb 1981
Clinical Trial Controlled Clinical Trial[Mechanics of breathing during anaesthesia with controlled ventilation by means of the engström ecs 2000 respirator (author's transl)].
Compliance, resistance, gas flow, blood gas tension and intrapulmonary shunt volume were measured in 20 anaesthetized patients ventilated by the volume-controlled Engström respirator ECS 2000. All patients had neurosurgical or vascular procedures. ⋯ Ventilation with the large tidal volume was characterized by better compliance and oxygenation indicating that the mechanics of breathing and the intrapulmonary gas exchange benefit from larger tidal volumes. Due to the special features of the Engström respirator as regards air flow and pressure steady ventilation with a low tidal volume of 6 ml/kg bodyweight does not result in a significant decrease in compliance and an increase in shunt volume as is the case with other types of respirators.
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J. Auton. Nerv. Syst. · Feb 1981
Role of baroreceptor reflexes in the hemodynamic and heart rate responses to althesin, ketamine and thiopentone anesthesia.
The effects of i.v. infusions of althesin, ketamine and thiopentone were studied in instrumental rabbits, in doses that produced similar levels of light anesthesia. The main hemodynamic differences were in the rises in mean arterial pressure (MAP) and in total peripheral resistance (TPR) which were in the order of ketamine greater than thiopentone greater than althesin. These rises in MAP and TPR did not occur in sino-aortic denervated rabbits suggesting that in normal rabbits these depended on the integrity of the arterial baroreceptors and /or chemoreceptors. ⋯ All drugs depressed the following curve parameters: (i) HP range, i.e. the difference in HP plateaux from maximal tachycardia to maximal bradycardia; and (ii) the reflex gain (sensitivity). The order of depression was ketamine greater than thiopentone greater than althesin, i.e. the same as the order in which they evoked pressor effects. The results suggest that the 3 anesthetics produce differing depression of afferent mechanisms related to baroreceptor reflexes and that this accounts for both the differences in pressor effects (through disinhibition of constrictor tone) and in depression of the vagal and sympathetic components of the baroreceptor--heart rate reflex.