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PubMed1999

AND and AND-OR drug mixture discriminations in rats: generalization to single drugs and drug mixtures.

RATIONALE: Studies of the discriminative stimulus effects of drug mixtures provide an approach to polydrug abuse and studies on single drugs with multiple effects. OBJECTIVE: This study was designed to investigate whether the use of the AND-OR procedure increases the specificity of drug mixture discriminations. METHODS: Rats were trained to discriminate a mixture of amphetamine (0.4 mg/kg) plus pentobarbitone (10 mg/kg) from saline (AND-discrimination, n = 8) or to discriminate the same mixture from its component drugs alone (AND-OR discrimination, n = 9). The studies used two-lever operant procedures with a tandem variable interval 1-min fixed ratio 10 schedule of food reinforcement. RESULTS: Under AND-discrimination conditions, there was partial generalization to nicotine and midazolam when each drug was administered singly, and there was no generalization to cocaine, caffeine or ethanol. With the AND-OR discrimination, there was no generalization to any of the preceding drugs administered singly. In "single substitution" tests, nicotine or midazolam was co-administered with the training doses of pentobarbitone and amphetamine, respectively; there was full generalization in the AND-discrimination and partial generalization under AND-OR conditions. Cocaine co-administered with pentobarbitone generalized fully under both procedures, but the dose of cocaine needed was much larger in the AND-OR than in the AND-discrimination. In "dual substitution" tests, mixtures of two novel substances were tested. Mixtures of either nicotine plus midazolam or caffeine plus ethanol produced very marked generalization under AND-discrimination conditions, but were without significant effect in the AND-OR procedure. Throughout the studies, in every instance where comparisons were made, generalization was greater or occurred at lower doses under AND- than under the AND-OR discrimination. CONCLUSIONS: The study yielded extensive evidence supporting the hypothesis that the AND-OR discrimination procedure increases the specificity of discriminations based on drug mixtures.

Animals↗

PubMed1995

Metabolic and functional mapping of the neural network subserving inferior collicular seizure generalization.

The sensory-motor portion of the inferior collicular cortex is capable of seizure genesis that is characterized initially by coincident wild running behaviors and localized electrographic afterdischarge. With repeated stimulations, this seizure activity spreads into the forebrain, producing generalized tonic-clonic or myoclonic seizure activity. In order to characterize the neural network subserving this caudal-rostral seizure generalization, three mapping techniques were used: 2-deoxyglucose (2-DG) utilization, c-fos expression and local anesthetic microinjection. Kindled seizure generalization from the inferior collicular cortex produced a global increase in 2-DG accumulation, while relative 2-DG increases were found in the inferior collicular cortex, dorsal lateral lemniscus, dorsal central gray, peripeduncular nucleus, medial geniculate nucleus, substantia nigra, entopeduncular nucleus, ventroposterior and centromedian thalamus and tenia tectum, as well as the perirhinal, somatosensory and frontal cortices. Kindled seizure generalization also increased c-fos-like immunoreactivity (FLI) in the inferior collicular cortex, cuneiform nucleus, dorsal lateral nucleus of the lateral lemniscus, peripeduncular nucleus, caudal central gray, dentate gyrus of the hippocampus, rhinal fissure area of the perirhinal cortex and the frontal cortex. Microinjections of procaine into the amygdala, perirhinal cortex, entopeduncular nucleus, substantia nigra, peripeduncular nucleus, dorsal central gray, and pontine reticular nucleus all prevented generalized seizure behaviors, but had no effect on the wild running seizures. Conversely, procaine microinjection into the area of the cuneiform nucleus/pedunculopontine tegmental nucleus prevented the wild running seizure but did not block the generalized seizure activity. Neither wild running, nor generalized seizures were altered following procaine microinjections into the anterior thalamus, sub-thalamus, lateral hypothalamus, hippocampus or deep superior colliculus. Thus, specific forebrain sites form a widespread neural network that mediates the generalization of seizure activity from the inferior collicular cortex into the forebrain.

Animals↗

PubMed1996

Generalization among related complex odorant mixtures and their components: analysis of olfactory perception in the spiny lobster.

We investigated the processing of odorant mixtures containing two to seven components by the spiny lobster Panulirus argus. The chemicals tested were food-related compounds that are attractive to spiny lobsters, and include adenosine-5'-monophosphate, betaine, L-cysteine, L-glutamate, DL-succinate, taurine, and ammonium. Components were tested at concentrations that produced search behavioral responses of equal magnitude in unconditioned animals. Responses of unconditioned animals to mixtures and their components reveal hypoadditivity, in which the response to a mixture is less than the sum of the responses to that mixture's components. Aversive conditioning coupled with generalization testing was used to evaluate generalization and hence perceptual similarity between related mixtures. Animals were conditioned to either an individual odorant, a four-compound mixture, or a seven-compound mixture, followed by generalization testing with submixtures or larger mixtures containing the conditioned stimulus. Animals tended not to generalize, but significant generalization between a more simple conditioned stimulus and more complex mixtures containing that conditioned stimulus occurred in 2 of 11 cases, and significant generalization between a conditioned mixture and its submixtures was observed in 4 of 9 cases. Both the number and chemical identity of components of mixtures may contribute to the degree of generalization between mixtures. Overshadowing, in which the ability to learn about a chemical is affected by simultaneous presentation of other chemicals, occurred in two of three cases. We discuss implications of these findings with respect to elemental and configural processing of odorant mixtures in the spiny lobster, possible neural mechanisms responsible for these results, and the potential utility of generalization and overshadowing to the spiny lobster's natural behavior.

Animals↗

PubMed1996

Intravenous trimethaphan during epidural plus general anesthesia decreases the direct radial artery pressure lower than the brachial artery pressure.

STUDY OBJECTIVE: To determine whether vasodilators such as sodium nitroprusside (SNP) and trimethaphan (TMP) produce a pressure difference between the radial artery and the brachial artery during epidural plus general anesthesia or simple general anesthesia. DESIGN: Randomized study and prospective study. SETTING: Operating rooms of two hospitals. PATIENTS: 36 and 6 adult patients in the first and second studies, respectively, who received spherical acetabular osteotomy with induced hypotensive anesthesia. INTERVENTIONS: In the first study, 18 patients received epidural plus general anesthesia (epidural group) and 18 patients received general anesthesia alone (general group). All patients received the hypotensive drugs for more than 50 minutes each. In the second study, 6 patients received TMP-induced hypotension for 20 minutes under epidural plus general anesthesia. MEASUREMENTS AND MAIN RESULTS: In the first study, radial intra-arterial blood pressure (RIBP) and tonometric blood pressure (TBP) calibrated with oscillometric blood pressure of the arm were compared. In the second study, RIBP and the brachial intra-arterial blood pressure (BIBP) were compared. In the first study, the bias between RIBP and TBP for systolic, mean and diastolic blood pressure were significantly less during TMP-induced hypotension in the epidural group (-11.5 +/- 2.5 (mean +/- SD), -6.0 +/- 3.1, and -2.8 +/- 3.7 mmHg, respectively] than during SNP-induced hypotension in the epidural group and SNP- and TMP-induced hypotension in the general group (p < 0.01). The precision of systolic and mean pressures were significantly greater during TMP-induced hypotension in the epidural group (11.8 +/- 2.3 and 7.1 +/- 1.9 mmHg, respectively) than the other three hypotension groups (p < 0.01). In the second study, the bias between RIBP and BIBP for systolic, mean, and diastolic pressures were significantly less (p < 0.01), and precision was significantly greater during hypotension than during normotension (p < 0.01). CONCLUSIONS: Our results demonstrate that TMP decreases the direct radial artery systolic and mean pressures to levels below the brachial artery systolic and mean pressures in patients who received epidural plus general anesthesia.

Adult↗

PubMed2004

Redefining the future of trauma surgery as a comprehensive trauma and emergency general surgery service.

BACKGROUND: Dwindling operative opportunities in trauma care may have a detrimental impact on career satisfaction among trauma surgeons and on career attractiveness to surgical trainees. Addition of emergency general surgery may alleviate some of these concerns. STUDY DESIGN: The trauma service at our institution incorporated nontrauma emergency general surgery over a 3-year period. The institution's trauma registry and hospital perioperative database were queried. The changes in operative caseload are described. Current trauma faculty anonymously completed a Web-based questionnaire about the addition of emergency general surgery to the trauma service. RESULTS: Operations for trauma decreased in 2002 compared with 1999, despite a higher number of penetrating injuries and total trauma contacts. Nontrauma general surgery operations performed by trauma faculty increased in proportion to coverage provided by the trauma service. In 2002, 57% of all cases performed by trauma surgeons were emergency general surgery, which accounted for 32% to 74% of an individual surgeon's caseload. In anonymously completed Web-based questionnaires, current trauma faculty expressed satisfaction with the combined trauma and emergency general surgery model. CONCLUSIONS: The combined trauma and nontrauma surgery service increased operative caseloads and improved satisfaction of trauma surgeons. A comprehensive trauma and emergency general surgery service may be an attractive model for the future of trauma surgery and provide logistical and medical advantages to the emergency general surgery patient population.

Clinical Competence↗

PubMed2005

Coexistence of focal and idiopathic generalized epilepsy in the same patient population.

PURPOSE: To review the clinical, electrographic, radiological, and pathological findings of patients with coexistent idiopathic generalized and partial epilepsy syndromes. METHODS: We performed a medical record review and a phone interview with all patients hospitalized to the Cleveland Clinic epilepsy monitoring unit (EMU) between 1992 and 2002 who fulfilled clinical and EEG criteria of coexistent partial and generalized epilepsy syndromes. RESULTS: Seven patients were identified. Two (29%) were men with a mean age of 26 years. Four had a history of febrile seizures. Family history was positive in five. Mean duration of the generalized epilepsy syndrome was 11 years, and of the focal epilepsy 18 years. An equal number of patients developed focal versus generalized epilepsy first. Interictal EEG activity was predominantly generalized. Four had video-EEG documentation of both types of seizures. In the rest, only focal seizures were recorded but interictal activity strongly suggested a coexistent generalized epilepsy. MRI showed hippocampal atrophy in all, and hippocampal dysplasia in three. Five patients had PET imaging, all with hypometabolism in areas corresponding to the ictal onset on EEG. Four patients underwent epilepsy surgery with good surgical outcome and pathological confirmation of hippocampal sclerosis in all. CONCLUSION: We found a 0.2% incidence of coexistent focal and primary generalized epilepsy. Febrile seizures and a positive family history were common. Good seizure control was achieved after temporal lobectomy, even when interictal generalized activity predominated.

Adolescent↗

PubMed1984

Stimulus generalization of conditioned taste aversion in rats.

Relatively little information is available regarding the intradimensional stimulus generalization of conditioned taste aversion (CTA). Experiment 1 employed a between-groups generalization test to examine the extent to which conditioned flavor aversion to one sucrose solution generalized to other concentrations of sucrose in adult rats. Evidence of a gradient of aversion was obtained. Because generalization gradients in other tasks have been found to flatten over a retention interval, Experiment 2 investigated the effects of delayed testing (2, 7, or 21 days) upon the slope of the generalization gradient. The generalization gradient flattened at the intervals, suggesting that subjects forgot the specific attributes of the conditioning concentration and avoided generalized stimuli as if they were the original CS. Experiment 3 used a long delay between taste and toxicosis to degrade the associative contingency and found no evidence that the generalization gradients found in the first two experiments could be explained in terms of enhanced neophobia due to poisoning. These findings provide further evidence (cf. A. W. Logue, 1979, Psychological Bulletin, 86, 276-296; M. Domjan, 1980, in J. S. Rosenblatt, R. A. Hinde, C. Beer, & M. Busnel (Eds.), Advances in the study of behavior, Vol. 11, New York: Academic Press) that CTA shares a number of similarities with other learning processes. Further, they illustrate that stimulus forgetting can be detected in a paradigm considered relatively immune to retention loss.

Animals↗

PubMed1996

Vascular surgical training of general and vascular surgery residents.

OBJECTIVE: The opinions of general surgery program directors (SPDs) and vascular surgery program directors (VPDs) regarding vascular surgery training of general surgery residents and the construct of the vascular surgery residency were compared. METHODS: Questionnaires were mailed to 55 VPDs and 290 SPDs in 1987 and 1988, and to 80 VPDs and 277 SPDs in 1995. Both questionnaires included questions regarding attitudes about vascular surgical competence, operative experience, future vascular practice opportunities of general surgery residents, and the impact of a vascular surgery residency on general surgery resident education. In addition, the 1995 survey included questions regarding the duration, content, and prerequisite versus requisite experience for the vascular surgery residency. RESULTS: Significant differences in opinions between SPDs and VPDs persisted regarding vascular surgery training of general surgery residents. SPDs were more likely to feel that general surgery graduates are fully competent in vascular surgery, should be exposed to more complex vascular surgery during training, and should be granted unlimited vascular surgical privileges on entering practice. Most VPDs felt that general surgery graduates lack competence in vascular surgery, should be exposed to less complex vascular surgery during training, and should have limited vascular surgery privileges in practice. Both groups of program directors agreed about the construct of vascular surgery residencies and that such residencies have had a favorable impact on general surgery resident education. Both SPDs and VPDs were willing to consider creative restructuring of vascular surgery residencies to accommodate governmental restrictions on funding of graduate medical education. CONCLUSIONS: External pressures forcing residency reform may provide an opportunity for SPDs and VPDs to creatively work with regulatory bodies to resolve differences in expectations of vascular surgery education and practice.

Attitude of Health Personnel↗

PubMed2002

Focal features in patients with idiopathic generalized epilepsy.

PURPOSE: The stringent dichotomy between focal and generalized epilepsies has become a contentious issue, since neuropathological studies as well as structural and functional imaging data hypothesized the existence of focal brain abnormalities in patients with well-documented idiopathic generalized epilepsy. The aim of our study was to investigate whether clinical and EEG features generally considered typical for a focal seizure disorder also occur in patients with generalized epilepsies to further support the hypothesis of a more continuous transition between focal and generalized epilepsies in contrast to the present concept of a stringent pathophysiologic dichotomy. METHODS: We retrospectively studied 20 consecutive patients with idiopathic generalized epilepsy who underwent video EEG monitoring either because of uncertainty of their epilepsy syndrome or because of a difficult to treat epilepsy. We determined the incidence of (a) focal interictal epileptiform discharges (IEDs), (b) intermittent temporal slow waves, and (c) clinical signs that are widely accepted as typical for a focal seizure onset, i.e. version, tonic/dystonic unilateral posturing, postictal hemiparesis, postictal nose wiping and figure of 4. RESULTS: Focal IEDs occurred in seven patients (35.0%), intermittent temporal slow waves in six (30%), and clinical signs pointing towards a focal seizure onset were found in seven patients (35%). CONCLUSION: Our study of EEG and clinical data supports the more sophisticated previous investigations in which structural and functional imaging as well as histopathological data suggested the presence of focal brain abnormalities in patients with 'generalized' epilepsies. Furthermore we emphasize the cautious use of isolated focal EEG abnormalities and certain clinical signs to prevent a premature diagnosis of focal epilepsy in patients who may indeed suffer from a generalized seizure disorder.

Age of Onset↗

PubMed1997

Comparison of general anesthesia with and without lumbar epidural for total hip arthroplasty: effects of epidural block on hip arthroplasty.

STUDY OBJECTIVES: To determine whether lumbar epidural anesthesia, when combined with general anesthesia, decreases perioperative blood loss, the incidence of postoperative deep vein thrombosis (DVT), cardiac dysrhythmias, and ischemia in patients undergoing total hip arthroplasty (THA). DESIGN: Randomized, controlled study. SETTING: A university hospital. PATIENTS: 37 ASA physical status I, II, and III patients, undergoing elective THA. INTERVENTION: Patients were divided into two statistically comparable groups: Group GA = general anesthesia; Group CEGA = general anesthesia plus lumbar epidural anesthesia. All patients had 48-hour perioperative Holter monitoring, applied on admission, the day prior to surgery. In both groups, general anesthesia was induced with thiopental sodium and muscle relaxant, and maintained with oxygen, nitrous oxide, isoflurane, opioid, and muscle relaxant. Group B received lumbar epidural anesthesia with 10 ml 0.5% bupivacaine with 1:200,000 epinephrine prior to anesthesia induction. Blood loss was measured by suction bottle contents, sponge weights, and collection drainage. DVT was assessed with postoperative leg scanning, plethysmography, and venogram. MEASUREMENTS AND MAIN RESULTS: Intraoperative blood loss was less after combined epidural-general anesthesia (663.8 ml +/- 299.0 ml) than after general anesthesia alone (1,259.2 ml +/- 366.0 ml). The difference was found to be statistically significant (p < 0.00005). No difference was found between the two groups in postoperative blood loss, incidence of DVT, cardiac dysrhythmias, or ischemia. CONCLUSION: Combined regional-general anesthesia decreases intraoperative blood loss in THA, and thereby offers an advantage over general anesthesia alone.

Aged↗

PubMed2003

Opportunistic screening for oral cancer and precancer in general dental practice: results of a demonstration study.

OBJECTIVES: To demonstrate the feasibility of opportunistic oral cancer and precancer screening in general dental practice and to determine the prevalence of relevant lesions and risk habits in a population of general dental practice attenders. DESIGN: A prospective demonstration study, recruiting patients opportunistically. SETTING: General dental practices. METHODS: Eighteen general dental practitioners took part in this study. Each attended training sessions to be advised of the study protocol and the criteria of a positive and negative screen. Patients over the age of 35 years were prospectively and opportunistically recruited. Each patient was asked to complete a health questionnaire concerning age, gender, ethnicity, smoking and drinking habits. The dentist then examined the soft tissues and recorded the presence or absence of lesions independently on a second form. The forms were collated and data were analysed to determine prevalence of lesions and associations with risk habits. RESULTS: Data on 2,265 patients were available for analysis. Oral lesions were detected in 319 patients (14.1%). Ninety-four patients (4.2%) had lesions considered to be either malignant or potentially malignant. There was a significant association between positive lesions and male gender(IRR 1.86, 95% CI 1.22-2.82), heavy smoking (males: IRR 3.68, 95% Cl2.10-6.43: female; IRR 3.58, 954b CI 1.35-9.50) and heavy alcohol use in males (IRR 2.98, 95%q CI 1.06-3.47). CONCLUSIONS: The results suggest that patients attending general dental practices are representative of the general population both in terms of lesion prevalence and high risk habits such as smoking and drinking. This supports the view that opportunistic screening in a general dental practice setting may be a realistic alternative to population screening. Further research is needed to determine the cost effectiveness of this approach and to investigate the value of targeting high risk groups within this population. General dental practice is ideal for the evaluation of such systems prior to extending these studies to other healthcare settings.

Adult↗

PubMed2000

Cross-modal generalization effects of training noncanonical sentence comprehension and production in agrammatic aphasia.

The cross-modal generalization effects of training complex sentence comprehension and complex sentence production were examined in 4 individuals with agrammatic Broca's aphasia who showed difficulty comprehending and producing complex, noncanonical sentences. Object-cleft and passive sentences were selected for treatment because the two are linguistically distinct, relying on wh-and NP movement, respectively (Chomsky, 1986). Two participants received comprehension training, and 2 received production training using linguistic specific treatment (LST). LST takes participants through a series of steps that emphasize the verb and verb argument structure, as well as the linguistic movement required to derive target sentences. A single-subject multiple-baseline design across behaviors was used to measure acquisition and generalization within and across sentence types, as well as cross-modal generalization (i.e., from comprehension to production and vice versa) and generalization to discourse. Results indicated that both treatment methods were effective for training comprehension and production of target sentences and that comprehension treatment resulted in generalization to spoken and written sentence production. Sentence production treatment generalized to written sentence production only; generalization to comprehension did not occur. Across sentence types generalization also did not occur, as predicted, and the effects of treatment on discourse were inconsistent across participants. These data are discussed with regard to models of normal sentence comprehension and production.

Adult↗

PubMed2001

Caseload in rural general surgical practice and implications for training.

BACKGROUND: Despite increasing specialization within general surgery, many general surgeons, particularly in rural practice, continue to treat a wide range of conditions. The aim of the present paper was to provide accurate information on three rural surgeons' case-loads to illustrate the spectrum of surgery encountered and to assist in the planning of rural general surgical training. METHODS: A review was conducted of a prospectively maintained database of operations performed by three rural general surgeons in different parts of Victoria, Australia over a 5-year period. RESULTS: A large volume and wide range of procedures was performed by each surgeon, who averaged more than 500 operations per year (excluding endoscopies). Although most were within the range of procedures covered in the Royal Australasian College of Surgeons (RACS) Fellowship in general surgery, some encroached upon other specialties such as orthopaedics, urology, paediatric surgery and obstetrics/gynaecology. Operations outside of 'general' surgery reflected individual training and local community needs. CONCLUSIONS: The current RACS Fellowship in general surgery, augmented by training in other specialties as required, will help prepare general surgeons for rural practice.

Curriculum↗

PubMed2005

Cardiac revascularization in specialty and general hospitals.

BACKGROUND: The emergence of specialty hospitals focusing on narrow procedural areas has generated controversy, although little is known about their quality. METHODS: We conducted a retrospective cohort study of 42,737 Medicare beneficiaries who underwent percutaneous coronary intervention (PCI) and 26,274 who underwent coronary-artery bypass grafting (CABG) during 2000 and 2001 in specialty cardiac hospitals (15 for PCI and 15 for CABG) and general hospitals (82 for PCI and 75 for CABG) in the same markets. Administrative data were used to compare patients' characteristics, hospital procedural volumes, and patient outcomes. RESULTS: Patients undergoing PCI or CABG in specialty hospitals were less likely to have coexisting conditions than those being treated at general hospitals and were less likely to have had an acute myocardial infarction (P<0.001). The better health of the patients at specialty hospitals than of those at general hospitals was reflected by the lower mean predicted risk of death (2.1 percent vs. 3.1 percent for PCI and 5.0 percent vs. 5.8 percent for CABG; P<0.001 for each comparison). Mean volumes of PCI and CABG procedures in 2000 and 2001 were higher in specialty hospitals than in general hospitals (799 vs. 375 PCI procedures, P<0.001; and 571 vs. 236 CABG procedures, P<0.001). The unadjusted rate of death during the index hospitalization or within 30 days after admission was lower in specialty hospitals than in general hospitals (2.1 percent vs. 3.2 percent for PCI and 4.7 percent vs. 6.0 percent for CABG; P<0.001 for both comparisons). In multivariate analyses adjusted for patients' characteristics, the odds ratio for death after PCI in specialty hospitals and general hospitals was similar (0.89; 95 percent confidence interval, 0.69 to 1.15; P=0.39), but the odds ratio for death after CABG was lower in specialty hospitals than in general hospitals (0.84; 95 percent confidence interval, 0.72 to 0.99; P=0.05). In stratified analyses comparing specialty and general hospitals with similar volumes, differences in mortality were not significant. CONCLUSIONS: The lower unadjusted mortality rate after cardiac revascularization in specialty cardiac hospitals is accounted for by their healthier patients and higher procedural volumes.

Aged↗

PubMed2000

A comparison of spinal, epidural, and general anesthesia for outpatient knee arthroscopy.

UNLABELLED: We compared general, epidural, and spinal anesthesia for outpatient knee arthroscopy (excluding anterior cruciate ligament repairs). Forty-eight patients (ASA physical status I-III) were randomized to receive either propofol-nitrous oxide general anesthesia with a laryngeal mask airway with anesthetic depth titrated to a bispectral index level of 40-60, 15-20 mL of 3% 2-chloroprocaine epidural, or 75 mg of subarachnoid procaine with 20 microg fentanyl. All patients were premedicated with <0.035 mg/kg midazolam and <1 microg/kg fentanyl and received intraarticular bupivacaine and 15-30 mg of IV ketorolac during the procedure. Recovery times, operating room turnover times, and patient satisfaction were recorded by an observer using an objective scale for recovery assessment and a verbal rating scale for satisfaction. Statistical analysis was performed with analysis of variance and chi(2). Postanesthesia care unit discharge times for the general and epidural groups were similar (general = 104+/-31 min, epidural = 92+/-18 min), whereas the spinal group had a longer recovery time (146+/-52 min) (P = 0.0003). Patient satisfaction was equally good in all three groups (P = 0.34). Room turnover times did not differ among groups (P = 0.16). There were no anesthetic failures or serious adverse events in any group. Pruritus was more frequent in the spinal group (7 of 16 required treatment) than in the general or epidural groups (no pruritus) (P<0.001). We conclude that epidural anesthesia with 2-chloroprocaine provides comparable recovery and discharge times to general anesthesia provided with propofol and nitrous oxide. Spinal anesthesia with procaine and fentanyl is an effective alternative and is associated with a longer discharge time and increased side effects. IMPLICATIONS: For outpatient knee arthroscopy, anesthesia can be provided adequately with regional or general anesthesia. Epidural and general anesthesia provide equal recovery times and patient satisfaction, whereas spinal anesthesia may prolong recovery and have increased side effects. The choice of anesthesia may depend primarily on the patient's interest in being alert or asleep during the procedure.

Adult↗

PubMed1994

General anesthetic techniques.

General anesthesia is the most common form of anesthetic management for ambulatory surgery. Patients, in general, prefer general anesthesia because it is less anxiety provoking. During the last decade, the availability of several short-acting agents with high clearance has made general anesthetic techniques much safer and more predictable for outpatients. Besides, general anesthesia today is associated with a quick and full recovery with minimal postoperative side effects. Proper preanesthetic psychological and, when necessary, pharmacological preparation as well as proper selection of anesthetic agents are the keys to the success of general anesthetic technique for ambulatory surgery. Although both TIVA and total inhalation anesthetic techniques have their advocates, balanced anesthesia is most popular. The introduction of several new agents (e.g., propofol, desflurane, vecuronium, atracurium, mivacurium, rocuronium, alfentanil, ondansetron, ketorolac) has made ambulatory general anesthesia less challenging and more interesting. In the future, the new anesthetic sevoflurane, and the new opioid remifentanil, may prove useful for ambulatory anesthesia. The LMA has all but revolutionized airway management during general anesthesia for ambulatory surgery.

Ambulatory Surgical Procedures↗

PubMed1998

Oxygen saturation during esophagogastroduodenoscopy in children: general anesthesia versus intravenous sedation.

BACKGROUND: Hypoxia may occur in children undergoing upper digestive endoscopy under sedation. The purpose of this study was to compare the occurrence of desaturation during intravenous sedation with that which occurs during general anesthesia. METHODS: Thirty-six patients between 3 months and 6 years old underwent a diagnostic esophagogastroduodenoscopy under sedation (n = 18) or general anesthesia (n = 18). Oxygen pulse oximetry, heart rate, and mean arterial pressure were monitored throughout the procedure. At the end of the procedure, the operator gave the value of the endoscopy satisfaction score on a scale of I (very good conditions) to IV (impossible procedure). RESULTS: The minimum oxygen pulse oximetry value was significantly lower in the sedation group compared with that in the general anesthesia group (89 +/- 5 vs. 97 +/- 1; p < 0.001). In the general anesthesia group, the oxygen pulse oximetry level declined to less than 95% in only one child; but in the sedation group, it declined to less than 95% in 16 patients (5.5% vs. 89%). Nine patients had a profound desaturation in sedation group (oxygen pulse oximetry < 90%); no patients in the general anesthesia group had desaturation (50% vs. 0%). In the general anesthesia group, heart rate and mean arterial pressure remained stable during the whole procedure, whereas in the sedation group, heart rate and mean arterial pressure increased significantly during the procedure. The endoscopy satisfaction score was I in all 18 patients in the general anesthesia group, whereas in the sedation group, it was I in only 2 patients, II in 8 patients, and III in 10 patients. CONCLUSIONS: These results confirm that hypoxia during upper digestive endoscopy in patients under sedation is a frequent occurrence in children. When compared with sedation, general anesthesia is a safer technique that prevents hypoxia and allows the gastroenterologist to perform the endoscopy under better conditions.

Anesthesia, General↗

PubMed2004

Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia.

STUDY DESIGN: A case-controlled, comparative study of 400 patients undergoing lumbar surgery, treated with either spinal or general anesthesia. An independent observer analyzed outcomes. OBJECTIVES: To determine the rate and type, of perioperative complications associated with each anesthetic method among lumbar surgery patients. SUMMARY OF BACKGROUND DATA: Spinal anesthesia is infrequently used for spinal procedures. While complications associated with spinal anesthesia are rare, some authors have suggested that spinal anesthesia may exacerbate existing neurologic disease and have recommended against its use in lumbar disc surgery. Others have found the technique safe and effective. General anesthesia may be preferred because it is seen as the routine accepted practice, because of greater patient acceptance and the ability to perform longer operations, or because of a general sense that general anesthesia is "safer" in these procedures. METHODS: Patients treated between 1994 and 1998 were matched for anesthetic class, preoperative diagnosis, surgical procedure, and perioperative protocols. All patients were treated according to a uniform protocol and recovered in the same perianesthetic environment. Data from the intraoperative period through hospital discharge were collected and compared. RESULTS: A total of 200 patients were included in each group. Overall complication rates and time to discharge were significantly lower in spinal anesthetic patients. Total anesthetic and operative times were significantly longer for general anesthetic patients, and perioperative heart rate and mean arterial pressures were elevated compared with those in spinal anesthetic patients. Nausea, requirements for antiemetic medication, and the incidence of urinary retention were significantly increased among general anesthesia patients. Spinal anesthesia patients had fewer spinal headaches compared with the general anesthetic group, but statistical significance was not obtained. CONCLUSIONS: For patients undergoing decompressive lumbar surgery, spinal anesthesia is at least comparable to general anesthetic with respect to complications. Specific advantages to spinal anesthesia include decreased nausea and antiemetic requirements, reduced analgesic requirements, and reduced overall complication rate.

Anesthesia, General↗