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PubMed1987

The value of maternal and fetal blood gas analysis in cesarean sections under general anesthesia.

Maternal and fetal blood gas values were studied in 90 selected mothers of comparable age, weight, duration of pregnancy and hematocrit values undergoing cesarean section under balanced general anesthesia in four differing clinical situations: elective with and without placental dysfunction, and emergency with and without fetal distress in apparently normal mothers. Pre-induction (Fi O2 0.21) and pre-delivery (Fi O2 0.60) maternal blood gas analysis, along with umbilical cord blood gas analysis were performed in all cases. Apgar scoring was carried out at one minute and three minutes and correlated with the blood gas values. Out of the 90 cases studied, 36 neonates (40%) showed good apgar scores of greater than seven at one minute and three minutes and correlated well with maternal blood gas values which were within normal ranges. Of the remaining 54 cases (60%) with similar mean maternal gas values the neonates showed an apgar score of less than seven in the first minute. The score improved in three minutes in 35 of them (66%), and umbilical cord blood gas values showed a low pH (umbilical vein 7.22 +/- 0.02 units, umbilical arterial 7.21 +/- 0.01 units) but satisfactory pO2 (umbilical vein 39.4 +/- 1.9 torr, umbilical arterial 2.5 +/- 1.3 torr).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMedDate not supplied

[Usefulness of bispectral index in pharmaceutical cost reduction for anesthesia].

BACKGROUND: The bispectral index (BIS) is a value derived from an electroencephalograph (EEG); it is correlated with depth of sedation and loss of consciousness. Therefore, it has been considered that its control on sedation depth could influence cost saving in drugs as well as decreased anesthesia costs. METHODS: A total of 175 patients were studied. One hundred patients were given intravenous (i.v.) anesthesia, 50 were observed with a BIS monitor, and the remainder went into the control group. Seventy five patients were given balanced general anesthesia: fifty were observed with BIS monitor, while the remainder functioned as the control group. Drug consumption per patient was measured a to maintain BIS value between 60 and 40, and the cost was calculated. RESULTS: Average drug costs for anesthesia were greater in BIS-controlled groups. Anesthesia cost/h was lower in prolonged procedures (>4 h). The bispectral Index as a sedation monitor during anesthesia is an excellent tool, although it did not show a real economic advantage, and we considered that it world only be feasible during long-term procedures.

Anesthesia↗
PubMed1975

[Convulsive mechanism of ketamine anesthesia].

Experimental studies conducted on rabbits enabled the authors to reveal the central mechanism of the ketamine effect. Based on the experimental data obtained, the authors elaborated and used clinically the method of balance ketamine anesthesia consisting in a combination of ketamine with antispasmatic drugs: seduxen and mydocalm. This method of anesthesia is recommended for eliminating ketamine side effects.

Anesthesia, Intravenous↗
PubMed2001

Anesthesia and critical care of thymectomy for myasthenia gravis.

Myasthenia gravis is an autoimmune disease resulting from the production of antibodies against the ACh receptors of the neuromuscular synapse. The thymus gland is involved in the autosensitization process, and the disease frequently is associated with thymic morphologic abnormalities. There is a consensus that all adults with generalized MG should have a thymectomy. This recommendation has been propagated by the safety of the procedure and excellent outcome. Removal of as much thymic tissue as possible (anterior mediastinal exenteration) by transsternal approach is the logical goal of thymectomy in the treatment of MG. Transcervical approach and VATS, however, are less invasive and have been used in patients who have MG unaccompanied by thymoma. Optimization of the condition of the myasthenic patients can markedly decrease the risk of surgery and improve the outcome. Two techniques have been recommended for general anesthesia in the myasthenic patient. Because of the unpredictable response to succinylcholine and the marked sensitivity to nondepolarizing muscle relaxants, some anesthesiologists avoid muscle relaxants and depend on deep inhalational anesthesia, such as halothane, isoflurane, or sevoflurane, for tracheal intubation and maintenance of anesthesia. Others, however, use a balanced technique of anesthesia that includes the use of carefully titrated muscle relaxants. The most important preoperative factor predicting the need for postoperative mechanical ventilation is the severity of bulbar involvement (Ossermann group 3 and 4), usually indicated by significant dysphagia and dysarthria associated with borderline respiratory dysfunction. Thymectomy benefits nearly 96% of patients: 46% develop complete remission, 50% are asymptomatic or improve on therapy, and 4% remain the same. The time from diagnosis to surgery is shorter than 8 months, and mild or moderate myasthenic symptoms are the main prognostic factors that predict the best outcome after thymectomy.

Anesthesia↗
PubMed1996

[Anesthesia for thoracoscopy].

The thoracoscopy is used both for diagnosis and treatment of pleural and lung diseases. We describe our experience in managing anesthesia for such procedures, the number of which is increasing thanks to technical advances. We review 82 thoracoscopic procedures, 48 of which were video assisted. Sixty-two were performed under balanced general anesthesia (GA) with isoflurane, fentanyl and atracurium. Local anesthesia (LA) with fractionated doses of propofol and fentanyl was used in 20 cases. The mean age of patients receiving LA (63 +/- 17 years) was significantly greater (p < 0.05) than those receiving GA (49 +/- 13 years). ASA IV patients were given LA and sedation. Selective bronchial intubation was performed in 46 cases. Complications during surgery were severe hypoxemia (SpO2 < 85%) requiring suspension of selective lung ventilation in 8 cases, moderate hypoxemia (spO2 < 90% and > 85%) in 1 case, coughing in 3 cases and agitation in 1 case. Video-thoracoscopy is a safe technique that is less invasive than conventional thoracotomy. The number of applications is increasing, although its future place in thoracic surgery must still be determined.

Adult↗
PubMedDate not supplied

[Multicomponent general anesthesia using analgesic butorphanol tartrate (beforal) in thoracic surgery].

Two schemes of anesthesia were used in 34 patients, making use of beforal, an agonist-antagonist of opioid receptors, as an analgesic component of total anesthesia during operations on the lungs. To improve neurovegetative protection, adrenomimetic clofelin was added to the Ist scheme and neuroleptic droperidol to the IInd. Use of beforal as an analgesic component of balanced total anesthesia in thoracal surgery in combination with both clofelin and droperidol ensured a sufficient level of anesthesiologic protection. Combination of beforal with clofelin, however, prevented hyperdynamic circulatory reactions at traumatic stages of the operation and intubation of the trachea and stabilized thermal homeostasis parameters, this indicating a more potent neurovegetative protection in this scheme of anesthesia.

Adult↗