Articles: general-anesthesia.
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Malignant hyperthermia is a potentially fatal complication of general anesthesia that may occur with greater frequency in some patients with ptosis or strabismus. The history of our knowledge of this recently described condition is outlined. ⋯ A protocol for the treatment of the acute malignant hyperthermia crisis and guidelines for the management of susceptible patients are suggested. The medicolegal implications of the occurrence of such a crisis are discussed.
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Total intravenous anaesthesia is a feasible alternative to the use of inhalational agents and the rationale behind such a technique is presented. The various intravenous agents are discussed, particularly with regard to their suitability for this form of anaesthesia, and their physiological effects compared with those of the inhalational anaesthetics. Some of the problems associated with the use of total intravenous anaesthesia are mentioned.
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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.