General Anesthesia Research Papers - Academia.edu (original) (raw)

BACKGROUND Since there is a growing use of analgesia and sedation in spontaneously breathing patients undergoing diagnostic or therapeutic interventions, recommendations by national societies of anesthesiologists call for the application... more

BACKGROUND Since there is a growing use of analgesia and sedation in spontaneously breathing patients undergoing diagnostic or therapeutic interventions, recommendations by national societies of anesthesiologists call for the application of capnometry during all anesthetic procedures. METHODS We compared readings from a transcutaneous capnometer (Tosca) and an end-tidal capnometer (Microcap Plus) to P(aCO2) measurements made via arterial-blood-gas analysis. We studied 30 spontaneously breathing patients who were recovering from general anesthesia, and we used Bland Altman analysis to compare the capnometry readings to the arterial-blood-gas values. Expiratory gas samples for end-tidal capnometry were taken either from a conventional face mask or an oral/nasal cannula. RESULTS The Tosca significantly overestimates P(aCO2) (mean +/- SD difference 5.6 + 3.4 mm Hg). The Microcap Plus significantly underestimates P(aCO2) (mean +/- SD difference -14.1 +/- 7.4 mm Hg). There was no signific...

An understanding of how drugs are transferred between mother and fetus during the gestational period is an important medical issue of relevance to both therapeutic drugs and drugs of abuse. Though there are several in vitro and in vivo... more

An understanding of how drugs are transferred between mother and fetus during the gestational period is an important medical issue of relevance to both therapeutic drugs and drugs of abuse. Though there are several in vitro and in vivo methods to examine this issue, all have limitations. Furthermore, ethical and safety considerations generally preclude such studies in pregnant humans. PET and appropriately labeled compounds have the ability to provide information on both maternal-fetal drug pharmacokinetics and pharmacodynamics. We present here a nonhuman primate animal model and the methodology for combining PET and MRI to identify fetal organs and to measure maternal and fetal isotope distribution using (18)F-FDG and a whole-body imaging protocol to demonstrate proof-of-principle.

This article describes diagnostic arthroscopy and arthroscopic management of selected lesions in the standing equine patient. Details on case selection, patient and operating room preparation, and surgical technique are presented. This... more

This article describes diagnostic arthroscopy and arthroscopic management of selected lesions in the standing equine patient. Details on case selection, patient and operating room preparation, and surgical technique are presented. This information will add techniques that avoid general anesthesia to the equine surgeon's armamentarium.

An investigation of end-tidal carbon dioxide tension changes was carried out in 19 healthy adult patients undergoing laparoscopic cholecystectomy. Following induction of anaesthesia, and throughout surgery, the end-tidal carbon dioxide... more

An investigation of end-tidal carbon dioxide tension changes was carried out in 19 healthy adult patients undergoing laparoscopic cholecystectomy. Following induction of anaesthesia, and throughout surgery, the end-tidal carbon dioxide tension was continuously monitored by capnography. The value following carbon dioxide insufflation increased with time to reach a maximum value after 40 min. Correlation of the individual maximum end-tidal carbon dioxide tension during laparoscopy with the corresponding baseline value prior to carbon dioxide insufflation showed a positive linear relationship (correlation coefficient 0.86). The correlation showed that an end-tidal carbon dioxide tension of 5.32 kPa (40 mmHg) can be achieved during laparoscopy when the baseline value is adjusted to around 4.0 kPa (30 mmHg).

Aim Opioid detoxification by administering opioid-antagonists under general anaesthesia has caused considerable controversy. This study is conducted to determine whether rapid detoxification under general anaesthesia results in higher... more

Aim Opioid detoxification by administering opioid-antagonists under general anaesthesia has caused considerable controversy. This study is conducted to determine whether rapid detoxification under general anaesthesia results in higher levels of opioid abstinence than rapid detoxification without anaesthesia.Design Randomized controlled open clinical trial from September 1999 to August 2001.Setting Four addiction centres in collaboration with three general hospitals in the Netherlands.Participants A total of 272 opioid-dependent patients whose previous attempts to abstain were unsuccessful.Intervention Patients received rapid detoxification with general anaesthesia (RD-GA) or without general anaesthesia (RD).Measurements Urine screens and an interview (EuropASI) to assess opioid abstinence; two questionnaires (SOOS, OOWS) to measure withdrawal symptoms and one to measure craving (VAS).Findings One month after the intervention 62.8% of the patients in the RD-GA group and 60.0% in the RD group were abstinent for opioids (P = 0.71). No adverse events or complications occurred during RD; however, in the RD-GA group, five adverse events necessitated admission to a general hospital. The average 1-month cost for RD was €2517 versus €4439 for RD-GA.Conclusions Rapid detoxification under general anaesthesia did not result in higher levels of opioid abstinence than rapid detoxification without anaesthesia. The cost of the former intervention was much higher.

Acute parotid gland enlargement in association with general anesthesia is rare and has also been called anesthesia mumps. We present two patients who were scheduled for lumbar spine surgery under general anesthesia. Each developed acute... more

Acute parotid gland enlargement in association with general anesthesia is rare and has also been called anesthesia mumps. We present two patients who were scheduled for lumbar spine surgery under general anesthesia. Each developed acute unilateral parotid gland enlargement over one side of the face proven by sonography. Case 1: A 52-year-old man was scheduled for his third lumbar spine to first sacral spine surgery for scoliosis and spondylolisthesis. The patient was provided general anesthesia with oral endotracheal intubation and placed in the prone position with the neck flexed at approximately 10 degrees. The head was turned to the left side and the right side of the face was placed on a soft gel rolling pad. After 6 hours of surgery, swelling of the right parotid gland was noted upon endotracheal extubation. Twenty four hours later, the patient received sonographic examination of the salivary gland which showed dilatation of the right parotid duct with obstructive inflammation....

Purpose This review on ultrarapid detoxification examines the pharmacology, techniques, and efficacy of this potentially promising technique and contrasts it with conventional treatment modalities. Source The information found here is... more

Purpose This review on ultrarapid detoxification examines the pharmacology, techniques, and efficacy of this potentially promising technique and contrasts it with conventional treatment modalities. Source The information found here is derived from experiences at the Texas Tech University, government reports, and peer reviewed journals. Principal findings Incidence and prevalence of heroin use is on the rise. Social and treatment costs suggest that this problem is staggering. Approximately 400,000 patients are enrolled in or are actively seeking methadone therapy. While many of these individuals want to undergo detoxification, traditional techniques, including methadone tapering are usually unsuccessful. The withdrawal syndrome is extremely unpleasant, may be fatal, and deters patients from completing the detoxification process. Ultrarapid detoxification entails general anesthesia in conjunction with large boluses of narcotic antagonists. This combination allows the individual to com...

Surgical treatment for Parkinson’s disease has evolved from permanent removal of parts of the brain to minimally invasive surgical techniques such as deep brain stimulation. Ample evidence supports the efficacy and safety of DBS giving... more

Surgical treatment for Parkinson’s disease has evolved from permanent removal of parts of the brain to minimally invasive surgical techniques such as deep brain stimulation. Ample evidence supports the efficacy and safety of DBS giving rise to its use in other clinical settings such as benign tremors, dystonia, epilepsy and other neuropsychiatric disorders.

OBJECTIVE To analyze precipitating causes, outcomes and corrective strategies especially anesthetic related factors associated with reintubation after planned extubation in anesthetic technique of general anesthesia with endotracheal... more

OBJECTIVE To analyze precipitating causes, outcomes and corrective strategies especially anesthetic related factors associated with reintubation after planned extubation in anesthetic technique of general anesthesia with endotracheal intubation. DESIGN Prospective observational study. MATERIAL AND METHOD Incidents of reintubation after planned extubation were extracted from the Thai Anesthesia Incidents Study (THAI Study) database conducted between February 1, 2003, and January 31, 2004, and analyzed using descriptive statistics. RESULTS The total of two hundred and thirty four patients of reintubation after planned extubation (RAP) at the end of general anesthesia was reviewed in this study. The incidence of RAP was 27:10,000 and the incidence in the university hospital was similar to the tertiary and secondary care hospital. The incidence was increased in extreme age group (age < 1 and > 70 year). One hundred and fifty eight cases of RAP (67.5%) occurred in operating theater...

The orthopaedic surgeon brings to the operating room some of the greatest challenges for the anaesthesiologist. Various factors, such as age, health status, disease process, type and extent of operative procedure, provide differing... more

The orthopaedic surgeon brings to the operating room some of the greatest challenges for the anaesthesiologist. Various factors, such as age, health status, disease process, type and extent of operative procedure, provide differing circumstances, which an anaesthesiologist is obliged to cope with. This contrasts to other surgical specialities in which patient factors and operative procedures are much more predictable. The number of older patients in orthopaedics is steadily growing, and the anaesthesiologist has to take all measures to permit an early and efficient rehabilitation, a concept which is now widely recognized for improving the success of orthopaedic surgical procedures. Factors which may hinder this concept are post-operative pain, central nervous system dysfunction, fatigue, deep sedation, delayed enteral feeding and absorption. There is no evidence that regional anaesthesia without the use of the continuous regional analgesic technique decreases morbidity and mortality as compared to general anaesthesia, in this context. However, the advantages of continuous analgesia through a perineural spinal or epidural catheter are promising and deserve further investigation. The concept of the optimal post-operative multimodal regimen needs to be defined. The application of NSAID and paracetamol is an integral part of this concept, and the dose of opioids should be titrated to the lowest efficient dose needed. Thus, this chapter discusses the different controversies and future trends of anaesthesia with regard to the elderly in orthopaedic surgery.