Articles: general-anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients.
The mortality following surgical correction of upper femoral fractures was investigated in 578 patients, over the age of 50 yr, randomly allocated to receive spinal (bupivacaine) or general (enflurane or neurolept) anaesthesia. Thirty days after surgery the mortality was 6% after spinal and 8% after general anaesthesia (ns). ⋯ The estimated blood loss was smaller (P less than 0.05) in patients receiving spinal anaesthesia. Regardless of the anaesthetic technique, a high short-term mortality was related to age, male sex, and trochanteric fracture, whereas excess long-term mortality was related to male sex and high ASA scores.
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Ann Fr Anesth Reanim · Jan 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study of general and spinal anesthesia in elderly women in hip surgery].
The choice between regional versus general anaesthesia for elderly patients undergoing hip surgery is debated. It is vitally important to see if the type of anaesthetic administered affects per- and postoperative morbidity and mortality. Seventy women more than 75 yr old suitable for spinal anaesthesia were included in this study. ⋯ In patients having general anaesthesia, 22.9% developed bronchopneumonia as opposed to 8.6% in the spinal anaesthesia group (p less than 0.05). The mortality rate at three months was rather similar in the two groups. It was concluded that, in order to reduce the incidence of postoperative central dysfunction and bronchopneumonia, spinal anaesthesia should be preferred in geriatric patients for lower limb surgery.
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Randomized Controlled Trial Clinical Trial
Hemodynamics of the legs and clinical symptoms following regional blocks for transurethral surgery.
In a prospective clinical study we compared the hemodynamics and clinical symptoms following regional blocks and general anesthesia. 115 patients undergoing transurethral resection of the prostate were randomized to spinal (n = 62) and epidural (n = 53) blocks. An additional 10 patients received general anesthesia. Calf arterial flow, determined by strain gauge plethysmography (SGP), was similar pre- and postoperatively in the regional block groups but decreased in the general anesthesia group (p less than 0.05) on the 5th postoperative day compared to the preoperative day. ⋯ Antiembolism stockings offered no hemodynamic or clinical advantages. During the hospital stay (screening by Doppler and SGP) and 3 months of follow-up, no deep vein thrombosis or pulmonary embolism was diagnosed. 3 months after the operation, unspecific pain and/or weakness in the legs were reported by 12 patients in the spinal group, while the epidural group remained asymptomatic (p less than 0.01). We conclude that the predictive value of negative Doppler and SGP findings is good and that spinal and epidural blocks are hemodynamically advantageous as compared to general anesthesia.
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Randomized Controlled Trial Clinical Trial
Fentanyl-oxygen versus fentanyl-N2O/oxygen anaesthesia in children undergoing cardiac surgery.
Fentanyl-oxygen (fentanyl-O2) anaesthesia was compared to fentanyl-nitrous oxide/oxygen (fentanyl-N2O/O2) anaesthesia in 14 children undergoing cardiac surgery. Children were randomly assigned to one of the two techniques studied, with seven patients in each group. The mean age (mean +/- SE) was 3.9 +/- 0.75 years (0.5-8.25 years) and mean weight 14.7 +/- 2 kg (3.5-29.5 kg). ⋯ Similar phenomena were not documented in the fentanyl-N2O/O2 group. Our studies suggest that fentanyl-O2 anaesthesia in the schedule described, in children undergoing elective cardiac surgery for Tetralogy of Fallot, A-V canal, and transposition of the great arteries, is not sufficient to prevent elevation in systolic blood pressure despite fentanyl plasma concentrations in excess of 20 ng X ml-1. The addition of nitrous oxide prevents this phenomenon.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Vecuronium: onset of effect and intubation conditions in comparison to pancuronium and suxamethonium].
The onset of neuromuscular blockade following the i.v. injection of vecuronium and pancuronium 0.05, 0.08 or 0.1 mg/kg and suxamethonium 0.5 or 1.0 mg/kg was studied in 304 patients during induction of anaesthesia by means of the compound action potential derived from the adductor pollicis muscle, which was indirectly stimulated via the ulnar nerve. The intubation conditions 1-5 min after injection were assessed using a scoring system related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of extremities. Development of motor blockade was time- and dose-dependent. ⋯ Although suxamethonium acts the fastest and tracheal intubation can be achieved within 0.5-1.0 min, its use involves certain side effects and disadvantages. Vecuronium acts considerably faster than pancuronium and good or excellent intubation conditions are present within 2 min. Suxamethonium is no longer the muscle relaxant of choice for intubation except for crash intubation, e.g., in patients with a full stomach.