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PubMed2001

The attitude of the general public towards preoperative assessment and risks associated with general anesthesia.

PURPOSE: To survey the general public's attitude towards preoperative assessment and commonly perceived fears about general anesthesia. METHODS: A province wide telephone survey was conducted in Alberta. General and regional anesthesia were defined, a scenario involving major knee surgery was described, and participants were asked to choose between regional and general anesthesia. Respondents used a seven-point scale to rate the importance of seeing an anesthesiologist preoperatively and were questioned about the timing of such a visit. Attitudes towards commonly perceived fears associated with anesthesia were also assessed. RESULTS: A total of 1,216 people were surveyed. Over 30% of respondents felt that it was very important to see an anesthesiologist preoperatively, with a total of over 60% attributing a high degree of importance to this. Fifty percent felt that this assessment should occur on the day prior to surgery. A preference for regional or general anesthesia was not expressed in the situation. Approximately 20% of respondents were very concerned about brain damage, waking up intraoperatively and memory loss. Twelve percent were concerned about dying intraoperatively. Nine percent expressed concern about postoperative pain, with 12% reporting being concerned about nausea and vomiting. CONCLUSIONS: The general public considers anesthetic assessment on the day prior to surgery an important part of preoperative preparation. Fears of brain damage, death and intraoperative awareness associated with general anesthesia remain prevalent, suggesting that preoperative education of patients should address these concerns. The general population was less concerned about realistic fears such as nausea, vomiting and postoperative discomfort.

Adult↗
PubMed2004

Usefulness of epidural anesthesia in gynecologic laparoscopic surgery for infertility in comparison to general anesthesia.

BACKGROUND: Although the advantages of epidural anesthesia in open surgery have been established, its usefulness in the setting of laparoscopic surgery remains to be studied. METHODS: Patients undergoing laparoscopic surgery for infertility were randomly administered epidural anesthesia (group A, n = 11) or general anesthesia (group B, n = 9). The operation was performed under 4 mmHg pneumoperitoneum and in the 20 degrees Trendelenburg position. Respiratory function tests using a spirometer and blood gas analysis were performed during the intra- or perioperative period. Pain status was evaluated with visual analog scale scoring. The number of postoperative recovery days needed to resume daily activities was obtained by a questionnaire. RESULTS: Respiratory rate, minute volume, P(a)CO2, % vital capacity (VC), and forced expiratory volume in 1 s (FEV1) % were virtually constant throughout the study period in group A, whereas %VC was decreased immediately after operation in group B (p < 0.05). Minute volume immediately after operation was significantly increased in group B compared with group A (p < 0.01), suggesting shallow respiration in women undergoing general anesthesia. Observed pain scores on abdominal pain, shoulder pain, and dyspnea were very low during operation in group A. Pain scores immediately and 3 h after operation were also minimal in group A, whereas abdominal pain scores at these points were significantly higher in group B than those in group A (both p < 0.01). The number of days required for a half reduction in wound pain, trotting, and full recuperation for group A were less than those for group B (p < 0.05). CONCLUSIONS: Epidural anesthesia, when used in laparoscopic surgery for infertility treatment, has advantages over general anesthesia in terms of analgesic effects, postoperative respiratory function, and a return to preoperative daily activities.

Adult↗
PubMed1994

Thyroid surgery using monitored anesthesia care: an alternative to general anesthesia.

Forty consecutive patients undergoing thyroid surgery under local anesthesia (LA) by a single surgeon over a 5-year period were included in this retrospective review. In all cases, the indication for LA was patient request. The study included 29 females and 11 males with an average age of 44 years (range 22-66 years). Body habitus was thin in 12.5%, average in 67.5%, and obese in 20%. Operations consisted of 21 unilateral thyroid lobectomies, 3 partial thyroidectomies, 3 subtotal thyroidectomies, and 13 total thyroidectomies. The pathology revealed benign disease in 45% and malignant disease in 55%. All procedures were performed using lidocaine and/or bupivacaine to administer a deep cervical plexus block as well as a field block. Mild additional intraoperative intravenous sedation was provided in most cases. Two patients were converted emergently to general endotracheal anesthesia because of inability to tolerate LA in one and a seizure secondary to intraarterial injection of lidocaine in the other patient. There were no instances of wound infection hemorrhage, recurrent laryngeal nerve injury, or hypoparathyroidism. In conclusion, thyroid surgery in selected patients can be performed safely using LA by experienced surgeons. If patients are carefully prepared preoperatively, LA offers a simple and reasonable alternative to general anesthesia.

Adult↗
PubMed1992

Platelet aggregation in dogs after sedation with acepromazine and atropine and during subsequent general anesthesia and surgery.

Platelet aggregation and adenosine triphosphate (ATP) release were measured by use of the impedance method in blood samples obtained from 25 adult female Beagles before and after sedation with acepromazine (0.13 mg/kg of body weight) and atropine (0.05 mg/kg), and during general anesthesia. General anesthesia was induced by IV administration of thiamylal (average dosage, 2.1 mg/kg; range, 1.2 to 4.2 mg/kg) and was maintained with halothane in oxygen. Samples of jugular venous blood were obtained from each dog, using citrate as anticoagulant. Platelet count was done on each sample. Platelet aggregation and ATP released from the aggregating platelets were measured within 2.5 hours of sample collection, using a whole-blood aggregometer. Adenosine diphosphate (ADP) or collagen was used as aggregating agent. For each aggregating agent, platelet aggregation and ATP release were measured over 6 minutes. After sedation with acepromazine and atropine, significant (P < 0.01) reduction was observed in platelet count (from median values of 341,000 cells/microliters to 283,000 cells/microliters) and in the ability of platelets to aggregate in response to ADP (from 14.0 to 7.0 omega). During the same period, maximal release of ATP in response to collagen also was reduced (from 5.56 mumol to 4.57 mumol; P < 0.01); however, this difference ceased to be significant when ATP release was normalized for platelet count. During general anesthesia and surgery (200 minutes after sedation), platelet count and aggregation responses to ADP and collagen had returned to presedation values. None of the dogs in this study appeared to have hemostasis problems during surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Acepromazine↗
PubMed1990

Combined epidural and general anesthesia for abdominal aortic surgery.

The hypothesis that combined epidural and light general anesthesia for infrarenal abdominal aortic surgery is associated with a more stable intraoperative course and less postoperative morbidity than general anesthesia alone was tested. The authors compared intraoperative hemodynamic variables and postoperative morbidity between a group with combined epidural and general anesthesia (n = 30) and a group with general anesthesia (n = 19). Patients who had combined epidural and general anesthesia were given epidural bupivacaine intraoperatively and epidural morphine postoperatively. After cross-clamping of the aorta, cardiac index and pulmonary capillary wedge pressure did not change in the group with combined epidural and general anesthesia, whereas cardiac index decreased (mean change, 0.30 L/min/m2; P = 0.0006) and pulmonary capillary wedge pressure increased (mean change, 1 mm Hg; P = 0.007) in the group with general anesthesia. After unclamping, cardiac index increased in both groups (mean change, 0.26 L/min/m2, P = 0.002, and 0.30 L/min/m2, P = 0.001, respectively). Postoperatively, the necessity for ventilatory support and the incidence of respiratory failure were lower in the combined epidural and general anesthesia group than in the general anesthesia group (P = 0.0002 and P = 0.018, respectively). In addition, vasodilator therapy was required less frequently in the group with combined epidural and general anesthesia (P = 0.002). Duration of intensive care unit stay was shorter in the combined epidural and general anesthesia group (2.7 days v 3.8 days, P = 0.003). These data indicate that for infrarenal abdominal aortic surgery, combined epidural and general anesthesia is associated with more stable intraoperative hemodynamics and significantly less postoperative morbidity than general anesthesia alone.

Adult↗
PubMed2003

Adult strabismus surgery under propofol sedation with local versus general anesthesia.

PURPOSE: To compare operating room and hospital discharge times between adult strabismus surgeries using intravenous propofol sedation with local anesthesia versus those using general anesthesia. METHODS: Thirty adult patients underwent uncomplicated strabismus procedures performed by one surgeon using propofol sedation and local subtenon's anesthesia. These were retrospectively matched with adult patients undergoing similar procedures by another surgeon using general inhalational anesthesia. Only one muscle had undergone previous surgery, and no adjustable sutures were used. Times from incision closure to leaving the operating room (Out OR time), and to hospital discharge (DC time) are compared. RESULTS: Propofol/local Out OR times ranged 2 to 8 minutes (mean, 4.8). General anesthesia Out OR times ranged from 3 to 28 minutes (mean, 8.8) (means differ at P<.001). At 10 minutes, 100% of propofol patients left the OR, but only 63% of general patients had done so (P<.001). Propofol/local DC times ranged from 30 to 140 minutes (mean, 64.8). General DC times ranged from 68 to 325 minutes (mean 116.5) (means differ at P<.001). At 60 minutes after completion of surgery, 53% of propofol/local patients had left the hospital, whereas none of general patients had left (P<.001). At 2.5 hours after surgery, 100% of propofol/local patients had left the hospital, but 10% of general patients remained, with two staying more than 5 hours. CONCLUSIONS: Many adult strabismus surgeries may be performed more efficiently with intravenous propofol sedation and local subtenon's anesthesia than with general anesthesia. Times from the end of surgery to leaving both the OR and the hospital are decreased compared with those of general anesthesia. Extreme delays are rare with propofol/local, but they occurred with general anesthesia.

Adult↗
PubMed2002

The septohippocampal system participates in general anesthesia.

How the brain mediates general anesthesia is not known. We report that two interconnected structures in the forebrain, the medial septum and the hippocampus, participate in maintaining awareness and movements during general anesthesia. In the awake, freely behaving rat, inactivation of the medial septum or the hippocampus by local injection of a GABA(A) receptor agonist, muscimol, decreased the dose of a general anesthetic needed to induce a loss of the tail-pinch response or a loss of righting reflex. Septohippocampal inactivation also suppressed the behavioral hyperactivity or the delirium stage associated with general anesthesia. An increase and decrease of 30-50 Hz (gamma) waves in the hippocampus correlated with an increase and decrease in behavioral activity, respectively. Similar results were found for both volatile (halothane and isoflurane) and nonvolatile (propofol and pentobarbital) anesthetics. We conclude that the behavioral hyperactivity induced by a general anesthetic is mediated in part by the septohippocampal system, and that depression of the septohippocampal system increases the potency of a general anesthetic. It is suggested that more potent general anesthetics or adjuvants may be developed by maximizing the pharmacological depression of the septohippocampal system.

Anesthesia↗
PubMed2002

Regional anesthesia is a good alternative to general anesthesia in pediatric surgery: Experience in 1,554 children.

BACKGROUND/PURPOSE: Although caudal and spinal blocks are modern and safe techniques, in many centers children still are operated on under general anesthesia (GA), or the blocks are used for postoperative analgesia after GA in infraumbilical operations. The authors aimed to document the results and the complications of 1,554 regional anesthesia cases, thereby assessing their validity. METHODS: The analysis of 1,459 caudal and 95 spinal blocks cases collected until January 2001 in children from newborn to 12 years of age are documented retrospectively. The types of anesthesia analyzed in the study were caudal block (CB) only, CB plus GA, GA plus CB, GA plus spinal block, and spinal block only. RESULTS: There were 1,338 caudal and 95 spinal block cases that clinically were satisfactory. Because the duration of CB was not sufficient in 39 cases, GA was used. Failure to produce a CB occurred in 82 cases (5.57%). There were 257 of 1,338 patients operated on under GA and supported by caudal block for postoperative analgesia. CONCLUSIONS: Caudal anesthesia seems to be an inexpensive, simple, and effective technique not only as a supplement for postoperative analgesia, but also as a single method of anesthesia. and the authors recommend its use in a wider setting of clinical entities in infraumbilical surgical procedures of children.

Age Factors↗
PubMed1992

Trends in dental treatment rendered under general anesthesia, 1978 to 1990.

While it is generally accepted that the prevalence of dental caries is decreasing, many institutions report an increase in the demand for dental rehabilitation under general anesthesia. This paper compares the characteristics of patients and types of dental treatment delivered under general anesthesia at the same hospital during 1978-1980 and 1988-1990. Patient records for children, who received dental care under general anesthesia during the two time periods examined were reviewed. Demographic data as well as data pertaining to types of dental treatment performed were collected from each patient record. Demographic characteristics were analyzed with a chi square analysis, and results regarding the types of dental treatment were analyzed using a Students t-test. Results were considered significant at p less than 0.05. There were no statistically significant differences in gender or ethnicity of the patients treated during 1978-1980 compared to 1988-1990. There were statistically significantly more patients treated in the 4-6 age group during 1988-1990 than during 1978-1980. There were no statistically significant differences in the number of dental procedures completed per patient during 1978-1980 compared to 1988-1990 in any procedure category except for dental sealants. This study indicates that the majority of pediatric dental patients being treated under general anesthesia at this hospital facility, still require an extensive amount of restorative dental care. Although most children can be successfully treated in the dental office, there is a group of pediatric patients, who require dental treatment in the hospital, under general anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Dental↗
PubMedDate not supplied

A retrospective review of a service to provide comprehensive dental care under general anesthesia.

Day-stay general anesthesia is indicated for a number of dental reasons, not least for those patients who are unable to accept routine dental care. Since 1979, the Dental Hospital of the University of Newcastle upon Tyne, UK, has provided a weekly day-stay service for the dental care of such patients. Reviews of this service were undertaken in 1983 and again in 1993. The latter study investigated the provision of care for 265 patients and compared this with that for the 96 patients reviewed in the earlier study. This paper presents the results of the review and underlines the need for a very aggressive approach to preventive dental care for patients treated by this modality.

Adolescent↗
PubMed1976

[Seeking an ideal protocol for the stability of blood gases during general anesthesia for bronchosopies].

During general anesthesia for bronchoscopy, hypoxemia is a major risk, especially in patients with a severe intrapulmonary shunt. With the technique of apnea in pure oxygen, after one hour denitrogentation, and with an intake of 50 liters of oxygen per minute through the bronchoscope, the PaO2 was greater than 400 mm of Hg, but hypercapnia and acidosis occurred. To compensate the latter, five minute sessions of apnea, alternating with two minutes of jet hyperventilation, nevertheless, have the disadvantage of producing a Ventrui phenomena at the proximal end of the bronchoscope, hence a fall in FiO2 which was dangerous in these high risk patients. The authors propose a method so that the Venturi phenomenon, which cannot be prevented, occurs in pure oxygen.

Anesthesia, General↗