Articles: general-anesthesia.
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Sitting position during surgery of the posterior fossa is very convenient for the neurosurgeon but can be dangerous, specially concerning the risk of air-embolism. We discuss the major problems of this special position, and the modifications of respiratory and hemodynamic functions from our experience on 84 cases. We study the monitoring of these patients during surgery, with special emphasis on prevention and detection of air-embolism with the capnograph. With the protocol suggested we can avoid major risk in this position.
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A technique of jet ventilation under general anesthesia (Alfaterinse suxamethonium) was used in 67 patients, in 55 cases for multiple endoscopic examinations in a single stage, usually laryngoscopy in suspension followed by oesophagoscopy, and in 12 cases, for an operation on the larynx. Arterial gasometry (PaO2 and PaCO2) proved the efficacy of the method, the major risk remaining, in the opinion of the authors, the possibility of excessive pressure which may be avoided by strict supervision.
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An increased venous capacity and a decreased myocardial contractility can be expected in patients with an acute spinal cord lesion at or above T6. Both factors may contribute to a high incidence of arterial hypotension and pulmonary oedema in these patients especially during anaesthesia. ⋯ V. P. measurement and is particularly useful in patients with a sympathectomy secondary to spinal cord trauma.