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At least 73 records · Page 4Linked to original sources
PubMed2001

Cost analysis in vitrectomy: monitored anesthesia care and general anesthesia.

A retrospective study was performed to compare differences in hospital charges between monitored anesthesia care with retrobulbar block and general anesthesia among patients having vitrectomy. Of 128 consecutive patients undergoing vitrectomy between July 1996 and July 1997, group 1 received general anesthesia (n = 41), group 2 received monitored care anesthesia with retrobulbar block (n = 59), and 28 patients were eliminated from the study. There were significant differences in anesthesia charges, operating room charges, pharmacy charges, and total hospital charges between groups 1 and 2. Charges associated with monitored care anesthesia with retrobulbar block are 20% less than charges associated with general anesthesia. Fewer patients in group 2 required postoperative intravenous narcotics than in group 1.

Aged↗
PubMed1991

[The association of continuous peridural anesthesia with general anesthesia. Apropos of 2 accidents].

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.

Aged↗
PubMed1990

[Initial clinical experiences with the combination of catheter peridural anesthesia and general anesthesia].

From the international point of view, the combination of epidural anaesthesia and general anaesthesia is still under controversial discussion. We analysed 35 cases which were treated by this anaesthesiological method between 1987 and 1988. The catheter epidural anaesthesia showed advantages mainly in the postoperative course. Analgesia was nearly complete. Respiratory depression which is caused by systemically applied opiates was not observed. Sympathicolysis led to a good perfusion of the legs and enabled a quick overcoming postoperative intestinal atonia. During the operation above all the does of drugs with respiratory depressant effect could be diminished. The complications observed mainly included the cardiovascular system and consisted in decreases of arterial blood pressure and heart rate. Side-effects can be reduced to the greatest possible extent by correct application of this procedure.

Adult↗
PubMedDate not supplied

[Contribution of epidural anesthesia and general anesthesia to colon surgery].

The authors, having clinically observed favourable post operative effects on patients operated under combined general and epidural anaesthesia in digestive surgery, have proceeded to a retrospective and comparative study of the last 50 colic resections. They have observed: a +/- 50% reduction of the quantity of morphine used; a +/- 50% reduction of the time required for peristaltic resumption; a +/- 50% reduction of the time required for gastric intubation thereby contributing to carefree post-operation effects in colic surgery where a series of known complications are usually to be expected. They are of opinion that the benefit of epidural anaesthesia is due essentially to the preponderance of the para sympathetic nervous system allowing the release of some hormones with intestinal tropism as well as the disappearance of the negative action of the splanchnic vaso-constriction.

Aged↗
PubMed2001

Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery.

UNLABELLED: Thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) as well as total-IV anesthesia (TIVA) are both established anesthetic managements for thoracic surgery. We compared them with respect to hypoxic pulmonary vasoconstriction, shunt fraction and oxygenation during one-lung ventilation. Fifty patients, ASA physical status II-III undergoing pulmonary resection were randomly allocated to two groups. In the TIVA group, anesthesia was maintained with propofol and fentanyl. In the TEA group, anesthesia was maintained with TEA (bupivacaine 0.5%) combined with low-dose concentration 0.3-0.5 vol% of isoflurane (end-tidal). Changing from two-lung ventilation to one-lung ventilation caused a significant increase in cardiac output (CO) in the TIVA group, whereas no change was observed in the TEA group. One-lung ventilation caused significant increases in shunt fraction in both groups which was associated per definition with a significant decrease in PaO(2) in both groups but PaO(2) remained significantly increased in the TEA group (P < 0.05). We conclude that both anesthetic regimens are safe intraoperatively. However, TEA in combination with GA did not impair arterial oxygenation to the same extent as TIVA, which might be a result of the changes in CO. Therefore, patients with preexisting cardiopulmonary disease and impaired oxygenation before one-lung ventilation might benefit from TEA combined with GA. IMPLICATIONS: Fifty patients underwent lung surgery through the opened chest wall requiring ventilation of only one lung. Patients were randomly assigned to receive either general anesthesia alone or in combination with regional anesthesia via a catheter in the back. Oxygen content in the blood and blood pressure was better maintained in the group receiving the combination of general with regional anesthesia.

Adult↗
PubMed1992

[Loco-regional anesthesia vs general anesthesia in carotid endarterectomy. Response to the surgical stress].

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.

Aged↗
PubMed2005

Conscious cardiac surgery with cardiopulmonary bypass using thoracic epidural anesthesia without endotracheal general anesthesia.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of thoracic epidural anesthesia as an alternative technique to general anesthesia in patients undergoing cardiac surgery under cardiopulmonary bypass. DESIGN: A prospective study. SETTING: Tertiary referral heart hospital. PARTICIPANTS: Eleven patients underwent cardiac surgical procedures requiring cardiopulmonary bypass under thoracic epidural anesthesia from February to April 2004. INTERVENTIONS: An epidural catheter was inserted at C7 to T2 intervertebral space on the day before the operation. Subsequently, cardiac surgery was performed using cardiopulmonary bypass. MEASUREMENTS AND RESULTS: The midsternotomy approach was used in all the patients. Anticoagulation was achieved with 300 units/kg of heparin. Under normothermic cardiopulmonary bypass, 6 patients underwent closure of atrial septal defect, 3 underwent valve replacements, and 2 underwent coronary artery bypass surgery combined with valve replacements. Soon after establishing cardiopulmonary bypass, all but 1 patient developed apnea, which was reversed after termination of cardiopulmonary bypass. The mean cardiopulmonary bypass time was 102 +/- 28 minutes, the aortic cross-clamp time was 58 +/- 28 minutes, and the total duration of surgery was 229 +/- 64 minutes. There was no mortality or morbidity in this series. CONCLUSION: Cardiac surgical procedures requiring cardiopulmonary bypass may be performed under thoracic epidural anesthesia, without endotracheal general anesthesia.

Adult↗
PubMed1993

Neonatal regional anesthesia: alternative to general anesthesia for urologic surgery.

The physiologic immaturity of respiratory musculature and central respiratory control centers leads to an increased risk of apnea and respiratory complications following general anesthesia in the neonate. Regional anesthetic techniques such as spinal and caudal epidural anesthesia may obviate the need for general anesthesia and lessen the risks of perioperative morbidity. Although these techniques have been previously described in infants, the majority of reports focus on regional anesthesia during herniorrhaphy in the former, preterm infant. There is relatively little or no information concerning regional anesthesia during urologic surgery in infants, especially during the actual neonatal period (0 to 28 days). We report on three neonates (2.17 to 3.8 kg) who required anesthetic care during the neonatal period for various urologic procedures including cystoscopy, incision of a ureterocele, and vesicostomy placement. Either caudal or spinal anesthesia was successfully used in the awake infant without the need for supplemental anesthetic agents (intravenous or inhalational). The advantages, risks, and applications of regional anesthesia during urologic surgery in the neonate are reviewed.

Anesthesia, Epidural↗
PubMed1993

Effect of phenylephrine bolus administration on left ventricular function during high thoracic and lumbar epidural anesthesia combined with general anesthesia.

The effect of phenylephrine (PHE) boluses on left ventricular (LV) function was examined in patients without cardiovascular disease who developed arterial hypotension during high thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) (group 1) or lumbar epidural anesthesia (LEA) combined with GA (group 2). LV function was assessed by transesophageal echocardiography (TEE) before and after central venous injection of 1 microgram/kg PHE. Fractional diameter shortening (FDS), end-systolic wall stress (ESWS), and rate-corrected velocity of circumferential fiber shortening (mVcfc) were determined. PHE effectively restored arterial blood pressure in both groups with a peak effect between 30 and 45 s after injection. FDS was reduced from 38% to 25% (mean, P < 0.01) in group 1 and remained unchanged in group 2. ESWS increased from 70 to 143 x 10(3) dyne.cm-2 (P < 0.01) and from 57 to 86 x 10(3) dyne.cm-2 (P < 0.05), in groups 1 and 2, respectively. mVcfc was significantly reduced from 1.11 to 0.80 circ/s (P < 0.05) in group 1 and was not altered in group 2. The authors conclude that PHE given as an intravenous bolus to patients under high TEA plus general anesthesia causes a transient impairment of LV function.

Abdomen↗
PubMedDate not supplied

The effect of torsional muscle dysfunction and surgery on eye position under general anesthesia.

Under general anesthesia, normal eyes exhibit 2.0 degrees to 2.5 degrees of extorsion. To investigate the effect of torsional muscle dysfunction and surgery on eye position under general anesthesia, we measured the torsional change before and after torsional muscle surgery in 26 eyes of 18 patients with clinical torsional muscle dysfunction. Under general anesthesia, compared with normals, eyes with preoperative intorter overaction or extorter underaction demonstrated a significant intorsional change (P < .01). However, eyes with intorter underaction or extorter overaction did not demonstrate a significant extorsional change. Postoperatively, while patients remained under general anesthesia, intorter weakening procedures produced measurable extorsion while intorter strengthening procedures and extorter weakening procedures produced measurable intorsion. Superior oblique tenotomy produced a greater net torsional change than inferior oblique weakening surgery (P < .01). Under general anesthesia, eyes with preoperative torsional muscle dysfunction exhibit torsion in the direction consistent with the dysfunction. After surgery on the torsional muscles, a measurable torsional effect can be demonstrated while the patient is still under general anesthesia.

Adolescent↗