Articles: general-anesthesia.
-
Int Anesthesiol Clin · Jan 1981
ReviewHypoxemia and general anesthesia: an analysis of distribution of ventilation and perfusion.
There is now overwhelming evidence that anesthesia with and without muscle paralysis is associated with an increased inefficiency of gas exchange, with abnormal oxygenation and CO2 elimination. There is great variation in the degree of this change from individual to individual; it results from increased right-to-left intrapulmonary shunting, increased alveolar dead space, increased dispersion of VA/Q ratios, altered cardiac output, and changes of the ODC. In normal subjects the abnormality can be largely explained by mismatch of ventilation and perfusion. ⋯ They can persist, however, well into the postoperative period. Alterations of pulmonary function during anesthesia and surgery are rarely life threatening in the operating room. Awareness of the problems of hypoxemia during general anesthesia and an appropriate response by the anesthesiologist, however, is a prerequisite of good medical practice.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparative influences of epidural and general anaesthesia on deep venous thrombosis and pulmonary embolism after total hip replacement.
In an investigation on deep venous thrombosis and pulmonary embolism, where neither dextran nor antithrombotic drug prophylaxis were employed, 30 patients undergoing total hip replacement were randomly allotted to one of two groups receiving either epidural or general anaesthesia. The epidural group (n = 15) was given 0.5% bupivacaine with epinephrine (5 micrograms/ml) and this was prolonged into the postoperative period for pain relief. The general anaesthesia group (n = 15) was operated on under artificial ventilation with nitrous oxide/oxygen via an endotracheal tube and intravenously administered fentanyl and pancuronium bromide. ⋯ Further, the frequency of pulmonary embolism, as determined by pulmonary perfusion lung scanning, was lower in patients receiving continuous epidural block (2 of 15) than in the general anaesthesia group (7 of 15). Possible explanations for these findings are discussed, including a hyperkinetic lower limb blood flow and lower fibrinolysis inhibition activity in patients given epidural block. Lower blood transfusion requirements in patients given epidural block might also play a role, as well as a "stabilizing" effect of local anaesthetics on platelets, leukocytes and endothelial cells.
-
Southern medical journal · Jan 1981
Ligation of patent ductus arteriosus in premature neonates: anesthetic management.
A retrospective study covering a five-year period was conducted on 40 premature neonates who had had general anesthesia for surgical correction of patent ductus arteriosus. The anesthetic management of these patients was carefully reviewed. The mean weight at surgery was 1,243 gm, and the mean gestational age at birth was 29.5 weeks. ⋯ Two patients had massive blood loss intraoperatively. There were 12 postoperative deaths in the series, and 12 patients had serious long-term disability, many were combinations of hearing, visual, and psychomotor disturbances. Advances in neonatology, surgery, and anesthesiology have improved the outlook of these seriously ill patients.