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Results for “ANESTHESIA, GENERAL”

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At least 19 recordsLinked to original sources
PubMed1991

Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery.

The goal of this randomized study of high-risk surgical patients was to determine whether intraoperative thoracic epidural anesthesia in combination with light general anesthesia alters postoperative morbidity when compared to a standard technique of "balanced" general anesthesia. A total of 173 patients scheduled for abdominal aortic reconstruction were admitted to the study; 86 were to receive "balanced" general anesthesia (group 1) and 87 thoracic epidural anesthesia in combination with light general anesthesia (group 2). Preoperative evaluation included standard clinical tools, dipyridamole thallium gammatomography, and radionuclide angiography. In these patients, all of whom had peripheral artery disease, there were no significant differences in associated coronary artery disease, hypertension, and cardiovascular treatment. The distribution of left ventricular ejection fraction and the number of patients with thallium redistribution were not statistically different between the two groups. During the postoperative period, group 1 received analgesia of subcutaneous morphine (n = 35), epidural fentanyl (n = 30), or epidural bupivacaine (n = 21). In group 2, 6 patients with a nonfunctioning epidural catheter due to technical failure received a balanced general anesthesia and were eliminated from the study. During the postoperative period, group 2 received analgesia of subcutaneous morphine (n = 26), epidural fentanyl (n = 25), or epidural bupivacaine (n = 30). Cardiovascular morbidity did not differ between the two groups: 22 patients in group 1 and 19 patients in group 2 had a major postoperative cardiac event.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Combined epidural and general anesthesia versus general anesthesia in patients having colon and rectal anastomoses.

Three retrospective studies were conducted at St. Vincent's Hospital to compare the outcomes of colorectal anastomoses, with and without resections, with respect to anesthetic technique. Operations were performed upon patients anesthetized with either combined regional (epidural) and general anesthesia (CRAG) or general anesthesia alone (GA). Postoperative pain relief was achieved with either continuous epidural analgesia (CEA) in the CRAG group or with postoperative narcotics in the GA groups (GA/PN). In one group, a different regimen was introduced: combined epidural and general anesthesia with postoperative epidural morphine (CRAG/EDM). Overall, anastomotic leak rates and death rates were lower in the CRAG group, and the lowest incidence of anastomotic leak was reported in the patients receiving CEA. Thus the reduced leak rate was associated more with the postoperative analgesia regimen than with the anesthetic technique. An increased incidence of wound dehiscence occurred with postoperative epidural morphine analgesia.

Analgesia, Epidural↗
PubMed1991

[Comparison of changes in plasma catecholamines between general anesthesia and general anesthesia plus epidural block].

To investigate the stress-response during anesthesia-operation, 16 patients were allocated into either of two groups. Eight cases in Group A underwent an operation on the abdomen under general anesthesia, while the other eight cases in Group B were operated under general anesthesia plus epidural block. Plasma catecholamine levels were measured in all subjects during anesthesia operation procedure. A significant increase in the levels of plasma catecholamines was observed at 45 min after incision in Group A (1.82 +/- 0.48 vs. 0.94 +/- 0.19 ng/ml, P less than 0.05, paired t-test), while no change was seen in Group B during the whole procedure. The result may indicate that an operation on the abdomen rather than general anesthesia itself is responsible for the observed increase in plasma catecholamines level.

Adult↗
PubMed2005

[Combined local block anesthesia and general anesthesia in cleft lip repairing operation of infants].

OBJECTIVE: Summarizing the value and key point of combined use of local block anesthesia and general anesthesia in cleft lip repairing for infants. METHODS: Local block anesthesia and general anesthesia were combined to use in 120 cleft lip repairing operation of infants using Midazolam, Fentangl, Ketamine, Scoline (or Vecuronium) in intubation, and injecting 0.5% - 1% lidocaine of which contained 1/250 000 adrenalinum. While intubation and operation, BP, P, R, SpO2, T and ECG were observed clearly. After operation, extubation was delayed and breathing oxygen was used for infants with breathing airway infection. RESULTS: While operation, anesthesia of 120 infants was smooth. After operation, the infants regain conscious quickly and no accident occurred. CONCLUSION: For the cleft lip repairing operation to infants, as combined use of local block anesthesia and general anesthesia, anesthesia is smooth, internal environment of body is steady, bleeding is little, regaining consciousness is quick and the infants are safe.

Anesthesia↗
PubMed1996

Clinical aspects of CRNA practice. General anesthesia.

General anesthesia is a state of reversible, descending depression of the central nervous system that is induced by inhalational or intravenous drugs. Components of general anesthesia include hypnosis, analgesia, amnesia, and muscle relaxation. Recognized anesthesia providers include CRNAs and anesthesiologists. Improvements in pharmacologic agents, technology, and education of providers have sharply reduced morbidity and mortality associated with anesthesia.

Anesthesia, General↗
PubMed2003

Awareness under general anesthesia.

General anesthesia aims to eliminate patients' awareness of excruciating pain during surgery. Nevertheless, rare occurrences of patient awareness continue because the problem is not yet completely preventable. One study puts the incidence of awareness at 0.18% for patients receiving muscle relaxants and at 0.10% for patients not given relaxant drugs. Awareness experiences frighten patients and impact their implicit and explicit memories in ways that can leave a lifetime of residual emotional and psychological problems ranging from sleep disturbances, nightmares, and daytime anxiety that may subside with time to development of post-traumatic stress disorder. Most anesthetists monitor depth of anesthesia by assessing intraoperative hemodynamic responses to surgical stimuli--an approach questioned by some authors. Several depth-of-anesthesia monitors are available, but there is no ideal monitor that is 100% reliable. This review provides an overview of literature that reports findings associated with the monitoring and occurrence of intraoperative awareness. These studies indicate assessment methods that can be trusted when we provide general anesthesia and what measures can be taken to prevent recall by patients under general anesthesia.

Anesthesia, General↗
PubMed1988

[Caudal anesthesia combined with general anesthesia in comparison with general anesthesia in ambulatory circumcision].

In 100 boys (5.9 +/- 3.2 years old) undergoing outpatient circumcision, analgesia was provided with 0.375% bupivacaine 1 ml/year of age by caudal injection (group I), administered after induction of general anesthesia. This group was compared with 100 boys (6.3 +/- 3.4 years old), who received only general anesthesia (group II). The puncture technique described was free of complications and the caudal blocks were 98% successful. There was a great difference with regard to the levels of general anesthesia: the average enflurane concentrations required to block autonomic reactions during surgical intervention was 1.3 vol% in group I and 2.7 vol% in group II. The amount of pethidine needed for perioperative pain relief was 8 mg (+/- 5.7) in 17/100 of group I and 17.3 mg (+/- 6.8) in 91/100 of group II. In addition, paracetamol was given in 10/100 of group I and 30/100 of group II. The boys in group I showed calm postoperative behavior. In both groups there were only slight differences in hemodynamic parameters. Of the parents who answered our questionnaire (50 answers to 60 questionnaires), 68% were amazed at the duration of analgesia. During the late postoperative period, in group I there was an almost total absence of vomiting (4%), with an associated rapid return to normal feeding. In 83% the effect of late postoperative analgesia worked so well that no subsequent analgesic was given. In 15% the pain relief lasted 6.3 +/- 2.5 h. The excellent postoperative pain relief produced by caudal anesthesia justifies its frequent use for children subjected to genital surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetaminophen↗
PubMed2000

[Comparison of epidural anesthesia and general anesthesia for patients with bronchial asthma].

We prospectively investigated the incidence of asthmatic attacks in 94 patients (1.5%) who were diagnosed as definite asthma. We separated the patients into three groups: epidural anesthesia (n = 10) including combined spinal/epidural anesthesia (n = 7), combined epidural and general anesthesia (n = 23), and general anesthesia (n = 54). General anesthesia was induced with propofol or midazolam and maintained with N2O and O2 with sevoflurane in adults. Patients who underwent epidural anesthesia and combined spinal and epidural anesthesia showed no asthmatic attacks. The incidence of bronchospasm with combined epidural and general anesthesia was 2/23. The incidence of bronchospasm with general anesthesia was 4/54. Bronchoconstriction occurred after tracheal intubation in 5 patients except in one patient, in whom it occurred after induction of anesthesia with midazolam. All episodes of bronchospasm in the operative period were treated successfully. The frequency of bronchospasm did not depend on the severity of asthmatic symptoms or the chronic use of bronchodilators before operation. These findings suggest that tracheal intubation, not the choice of anesthetic, plays an important role in the pathogenesis of bronchospasm.

Adult↗
PubMed1995

[Comparison of changes in plasma concentrations of ACTH and beta-endorphin in cholecystectomy under general anesthesia and general plus epidural anesthesia].

OBJECTIVE: To study neuroendocrine response during cholecystectomy under general anesthesia with fentanyl and under general anesthesia with nitrous oxide plus thoracic epidural block, by determining plasma levels of ACTH and beta-endorphin. PATIENTS AND METHODS: This was a prospective study of 2 randomly chosen groups of 7 patients each who were undergoing cholecystectomy. One group received general anesthesia with fentanyl at initial doses of 10 micrograms/kg-1 followed by perfusion of 5 micrograms.kg-1.h-1. The other group received general anesthesia with 60% nitrous oxide in oxygen combined with bupivacaine 0.5% for thoracic epidural blockade. Plasma levels of ACTH and beta-endorphin were determined at the following moments: A, upon arrival in the operating theater; B, after anesthetic induction and intubation; C, after incision; D, 30 minutes after start of surgery; E, after surgery but before extubation, and F, after arrival in the recovery room. Also recorded were mean arterial pressure and heart rate. RESULTS: In both groups we found significantly higher levels of beta-endorphin throughout surgery. The increase was greater, however, in the group receiving combined anesthesia at moments D (p = 0.008) and E (p = 0.008). ACTH levels rose significantly during surgery (p = 0.004) in the combined anesthesia group, whereas there was only a slight increase in the group receiving only general anesthesia (p = NS). beta-endorphin levels increased proportionally more than ACTH levels during combined anesthesia. Hemodynamic stability was acceptable in both groups. CONCLUSION: General anesthesia with fentanyl at the dose used in this study was more effective that combined anesthesia in mitigating the release of ACTH and beta-endorphin during cholecystectomy.

Adrenocorticotropic Hormone↗
PubMed2000

Spinal anesthesia versus general anesthesia for hip fracture repair: a longitudinal observation of 741 elderly patients during 2-year follow-up.

The Baltimore Hip Studies, a multicenter, noninterventional, observational trial, provided an opportunity to investigate the effects of anesthetic technique on the long-term outcome of elderly patients after hip fracture repair. Detailed interviews assessing functional status and pain were conducted during the hospital stay. Out-of-hospital evaluations were repeated after the procedure at 2, 6, 12, 18, and 24 months with a portable gait and balance laboratory. Multivariate analysis was done to determine the effects of anesthetic technique on functional and other outcomes, after controlling for multiple baseline variables. Of 741 enrolled patients who completed the study, 430 and 311 patients received spinal anesthesia or general anesthesia, respectively. Subgroup analysis of three spinal anesthetics, tetracaine, lidocaine, and epinephrine, was also done. In the present large observational study, general anesthesia was at least as efficacious as spinal anesthesia, and possibly better, in affording good long-term outcome.

Activities of Daily Living↗
PubMed1985

[Respiratory functional hypoxia in ruminants under general anesthesia].

General anesthesia causes a marked hypoxia in ruminants. We compared this phenomenon with anaesthesia related changes in the dog. Under alfentanil/etomidat anaesthesia some variables of the pulmonary circulation (TPR, PAP, PCWP) as well as arterial and venous blood gases and saturation (HbO2, pO2, ph) in dogs, sheep and calves were measured and calculated. The calculated pulmonary shunt fraction was compared between the three species. In ruminants there was an increase of total pulmonary resistance being associated with elevated PAP and decreased PCWP. The pulmonary shunt fraction was increased significantly and markedly during the surgical tolerance period, too. These parameters were not significantly changed in the dog. Ruminants seem to take an exceptional position concerning the anaesthesia related alterations of the pulmonary ventilation/perfusion system.

Adjuvants, Anesthesia↗
PubMed1989

Utilization of general anesthesia by general practitioners in Saskatchewan.

A survey of Saskatchewan general practitioners was carried out to investigate the utilization of general anesthesia for the completion of dental procedures. Of the total number of general practitioners (234) surveyed, 61.5 per cent responded that they had done at least one general anesthesia case during their dental career. With respect to current utilization in the province, 38.4 per cent (90) of the respondents did at least five general anesthesia cases per year. Other variables investigated were: number of cases per year, types of patients treated and adequacy of dental school training. Age of practitioner, year of graduation and community population were found to be significant (p less than 0.001) variables in the utilization of general anesthesia by general practitioners in Saskatchewan.

Adult↗
PubMed2004

Stunning the neural nexus: mechanisms of general anesthesia.

General anesthesia requires managing a complex array of anesthetic agents that act on an intricate web of neural connections or neural nexus. Both inhaled and intravenous anesthetics must intervene at some level of the neural nexus that provides for amnesia, immobility, hypnosis, and suppression of noxious reflexes. These interactions occur at the spinal and supraspinal level and involve spinal pathways and centers of arousal and memory formation centrally. Current research does not support the notion of a unitary mechanism of action for general anesthetics, but rather that anesthetics act by altering neuronal ion channels and neural communication. In general, anesthetics act by either enhancing inhibitory transmission or blocking excitatory conduction in neural impulses. The potent inhaled agents and most intravenous agents enhance the inhibitory lambda-aminobutyric acid subtype A (GABAA) and glycine channels and depress the excitatory neuronal nicotinic acetylcholine (nnACh) receptors. Nitrous oxide and ketamine act primarily by depressing the excitatory N-methyl-D-aspartate (NMDA) receptors and enhancing the opioid mu receptors. The extent, distribution, and subunit composition of these receptors determine the effects of various anesthetic agents on an individual patient. This variability, both within the patient and among the mechanisms of action of anesthetics, provides a reasonable degree of flexibility to the clinical practice of anesthesia.

Anesthesia, General↗
PubMedDate not supplied

Endocrine-metabolic response to abdominal aortic surgery: a randomized trial of general anesthesia versus general plus epidural anesthesia.

The influence of epidural anesthesia on the endocrine-metabolic response following abdominal aortic reconstruction was studied in a prospective randomized trial. Cortisol and catecholamine responses and nitrogen balance were measured in two groups of five patients receiving general anesthesia only (group 1) or general anesthesia combined with epidural bupivacaine (group 2). The study lasted from preoperatively until the first postoperative day. At 2100 hours on the day of surgery serum cortisol concentrations were higher in group 1 than in group 2 (1.41 versus 0.82 mumol/L; p < 0.01). Likewise the total perioperative hypercortisolemia, expressed as the area under the curve, was significantly higher in group 1 (11.7 versus 5.7 mumol/L/hr, p < 0.01). Intraoperative urinary excretion of epinephrine and postoperative norepinephrine excretion were significantly higher in group 1 than in group 2. Urinary excretion of free cortisol and cumulative nitrogen balance were not different between the groups. Although the number of patients was limited and the sensory nerve block level was not measured perioperatively, this study suggests that epidural anesthesia attenuates the stress response to aortic surgery.

Aged↗