[The electroencephalogram in nitrous oxide anesthesia, automatic electroencephalographic anesthesia control].
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Forty patients aged 2 to 5 years who were admitted for paediatric operations were randomly assigned to have either spinal or general anaesthesia. Spinal anaesthesia was achieved with isobaric bupivacaine 0.5% at a dose of 0.5 mg/kg. General anaesthesia was induced with thiopentone 2-5 mg/kg and continued with low-dose fentanyl (1-2 micrograms/kg, oxygen/nitrous oxide/isoflurane (30/70/0.1-0.5%), vecuronium normoventilating the patients. The time spent in the operation room was shorter in the spinal anaesthesia group because the children were awake and could immediately be transferred. The haemodynamic pattern and respiratory function were stable during spinal anaesthesia. After general anaesthesia, respiratory function deteriorated as indicated by arterial desaturation (< 90%), which was detected in 11 of the 20 patients after general anaesthesia. Vomiting (2), sore throat (4) and micturition difficulties (2) were the adverse events associated with general anaesthesia. Three patients were restless after spinal anaesthesia. It can be concluded that spinal anaesthesia is a suitable anaesthetic technique for paediatric surgery.
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Our experience with anaesthetic combination of butyrophenone derivative droperidol (D, 0.8 mg/kg b.w.) + alpha-2-agonist xylazine (X, 5 mg/kg b.w.) + ketamine (X, 35 mg/kg b.w.), in 28 rats (12 female, 8 + 8 male) is described. Anaesthesia protocol started with ether inhalation (5 ml/l air) in a glass bell. When the effect of anaesthesia was evident, droperidol and xylazine with ketamine were administered in an intramuscular injection. At the same time as anaesthetics, atropine (0.05 mg/kg b.w.) was injected subcutaneously. Average time of induction of ether anaesthesia was 45 +/- 30 s. and duration of the surgical stage was 64 +/- 16 s. Average time of recurrence of the position reflex was 120 min. D + X + K anaesthetic combination is safe, cost effective, and it induces good analgesia and myorelaxation. Anaesthetic effect is possible to prolong with half dose of ketamine with half dose of droperidol or xylazine in 30 to 40 min. interval and the next prolongation is possible in 20 min. interval. The presented combination of anaesthetic was used for the soft tissue surgery (laparotomy, thoracotomy, and cannulation of large vessels--a. carotis, v. jugularis), both in experiments and clinical praxis.
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Association of locoregional techniques such as deep and superficial cervical block, lumbar epidural and/or peripheral blocks, and conscious sedation with hypnotic drugs (propofol 1-3 mg/kg/h or midazolam 2-4 mg/h) and/or opiates drugs (sufentanil 5-10 mcg or remifentanil 0.05-0.1 mcg/kg/min) is actually, the gold standard for vascular surgery. Our personal experience is based on 328 patients submitted to carotid endarterectomy, aneurysm repair and peripheral surgery.
The advantages of performing carotid endarterectomy in the awake patient, perioperative analgesia, circulatory parameters, plasma cortisol and PRL response to surgery have been evaluated. Ten patients were submitted to general anaesthesia and ten patients to superficial and deep cervical block. The Authors conclude that, although the number of patients studied is limited, there are no significant differences between the two groups for intraoperative analgesia, hemodynamic imbalance and plasma cortisol and PRL. This result support the belief that carotid endarterectomy in awake patients can be safely performed on patients with chronic obstructive pulmonary disease.
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Using two different anaesthetic techniques, the author have investigated the cytotoxicity in process during abdominal surgery. In these investigations, no significant differences have been demonstrated in the behaviour of the NK with the two techniques adopted. The increase noted in traceable to the mobilization of the N.K. of the extra vascular deposits. The increase of the cytotoxic activity is probably traceable to the action of the endogenous opiate substances.
Continuous lumbar epidural anaesthesia combined with light general anaesthesia provides optimal anaesthetic conditions to realize major lower abdominal or pelvic surgical cases. However this technique may cause haemodynamic alterations due to the important vasoplegia and to the potential myocardial toxicity of the local anaesthetics. The authors report two accidents associated with this technique, one of them with lethal outcome.