Articles: postoperative-complications.
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A hypothesis of the pathophysiology of midcervical quadriplegia after posterior fossa operation with the patient in the sitting position under general anesthesia is presented. Observations and experimental evidence are presented to support the theory that stretch of the cervical spinal cord associated with neck flexion may be sufficient to impair the autoregulation of spinal cord blood flow enough so that the reduced, but otherwise acceptable, hemodynamic parameters associated with general anesthesia in the sitting position contribute to the risk of spinal cord infarction.
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In summary, it is clear that duration of surgery is positively correlated with postoperative morbidity in both major and relatively minor procedures. It should be kept in mind that the reason for this in many cases may be that the preoperative condition of the patient or the nature of the surgical procedure can affect both operative time and postoperative outcome. ⋯ It can be said, too, that the anesthetist will be more likely to see arrhythmias the longer the surgeon operates. The association of myocardial infarction, renal failure, thromboembolic disease, and delirium with prolonged operation time is also a possibility.