Case 3--1992. General anesthesia complicated by unexpected hypertension and tachycardia.
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Maternal lung edema due to the use of beta-mimetic tocolytic agents is a well-documented complication. The risk increases if several other factors are present: infectious diseases, the use of inhaled anesthetics, EPH gestosis, hydramnios, twin gestation and preexisting cardiovascular disease. The complications induced by beta-mimetic tocolytic agents can be reduced by remembering their side effects and contraindications and restricting fluid intake. During obstetric general anesthesia in patients undergoing tocolysis, the infusion of large amounts of saline, as is widely practised today, is strictly contraindicated.
Arterial blood-gas changes were studied in 21 healthy women undergoing laparoscopic sterilization with local anesthesia and supplemental IV sedation, employing CO2 as the inflating gas. No significant hypercarbia was noted. Two patients became transiently apneic following IV medication and 2 became extremely agitated during the procedure. This constituted a major nonsurgical complication rate of 19 percent. Safety requirements for patients undergoing this procedure is suggested.
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Complication and side effects of spinal anesthesia have been studied in 2603 patients. The following complications of spinal anesthesia have been observed: transient and prolonged arterial hypotension; marked respiratory and circulatory depression; neurological consequences and early and late respiratory depression associated with intrathecal administration of narcotic analgesics. Side effects comprised vomiting, nausea, transitory urination disturbances, and itching. The dependence of the number of complications and side effects on the level of puncture, the patient's age and concentration of the anesthetic introduced into subarachnoidal space has been established.
For various reasons, repair of inguinal hernias under local anesthesia is not well accepted. The purpose of this study is to evaluate the effectiveness of local anesthesia in inguinal hernia repairs. One hundred consecutive inguinal herniorrhaphies are reported. The selection of patients, surgical technique, and incidence of intraoperative and postoperative complications are reported. Patient acceptance and their immediate postoperative course are also described. The study demonstrates that inguinal hernias can be easily repaired under local anesthesia, complications are minimal, and patient acceptance, excellent. We strongly recommend thath this form of anesthesia be used in the "routine" repair of inguinal hernias in cooperative patients.
Extracorporeal shock-wave lithotripsy (ESWL) has been widely introduced in the treatment of nephro-uretero-lithiasis during the last decade as it provides a noninvasive removal of the stones from the upper urinary tracts. The paper covers the history, techniques, indications, contraindications, anesthesia, complications and results of the method. Positive and negative characteristics of ESWL equipment (lithotriptors) are considered. The experience with 5000 lithotripsies led the authors to the conclusion that ESWL does not solve all the problems in the treatment of nephro-uretero-lithiasis and should be introduced only in large clinics practicing actively x-ray endoscopy and equipped with modern endoscopic and ultrasonic urologic units.
The combining of elective procedures, including dentistry, in a single hospital admission, under general anesthesia, can be a very beneficial service for those patients, for whom such procedures are indicated. By minimizing the number of hospitalizations and the number of general anesthetic procedures for his patients, the pedodontist is reducing the risk of anesthesia complications, the possibility of psychological trauma, and the financial burden of hospital treatment. In addition, he promotes the role of the pedodontist in the community and in the hospital as an integral member of the child's health-care team.
Maternal and perinatal mortality are important health problems in the United States. Emerging causes of maternal deaths are embolism, cardiomyopathy, anesthesia complications, adult respiratory distress syndrome, and acquired immunodeficiency syndrome. Maternal deaths continue to be underreported. Active surveillance is needed to better identify maternal deaths and to understand their causes and risk factors. Although perinatal deaths have declined recently--primarily because technologic advances have improved low-birth-weight babies' chances for survival--they remain a problem, particularly among blacks. Clinicians should strive to reduce preventable deaths among black normal-birth-weight babies and to prevent low birth weight and premature birth among black infants. Future research should focus on determining whether early prenatal care and cesarean delivery actually reduce perinatal mortality. A better understanding of prenatal and intrapartum care and their benefits will help in the development of strategies to reduce perinatal and maternal deaths.
Of 3632 consecutive admissions to the Wilmer Ophthalmological Institute between July 1, 1987 and June 30, 1989, 27 patients required transfer to a medical or surgical service (0.74%). The major reasons for transfer included acute or decompensated cardiac disease (26%), poorly controlled diabetes mellitus (19%), acute renal failure (11%), coagulopathy, stroke, and hypertension (7% each). Only one transfer was a direct result of an anesthesia complication. The highest rates of transfers were associated with orbital (4.3%), enucleation/evisceration (3.1%), and glaucoma (2.3%) surgeries, while vitreoretinal surgery had the lowest rate of transfer (0.3%). Most of the transfers of patients with orbital disease were for management of related problems such as sinusitis or increased intracranial pressure.
Sonographic guidance with 41 punctures and 38 catheterizations was employed in 68 patients. The approach was either intercostal or subxiphoid. Most punctures were performed with a 1.4-mm-thick plastic-sheathed cannula after local anesthesia. Complications were observed in 7 patients. In one patient a catheter introduced with a movable core-type guidewire pierced the right ventricle wall with uneventful recovery after surgery. Intercostal drainage caused pleural pain in 2 patients, and in 2, leakage to the pleural space. Two patients with heart transplants had severe bradycardia and drop of blood pressure, one after needle drainage and the other during guidewire manipulation. Direct monitoring generally ensures a correct position of the instruments and hazards to adjacent organs can be avoided. In small effusions a simple needle aspiration with a plastic-sheathed cannula is safer than catheter drainage.
This study reports retrospectively the post-anaesthetic complications in surgical out-patients. We have studied the incidence and severity of these complications during the first five post-operative days in 500 female patients who underwent tubal ligation by laparoscopy. The report shows that post-anaesthetic complications in surgical out-patients are frequent but of mild severity. Although they produced some discomfort for the patients most of them were of the opinion that the advantages of having the operation as out-patients made up for the discomfort.
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A mail questionnaire was sent to Finnish anaesthetists and paediatricians to evaluate the risks of reproductive, teratogenic and health complications related to the professions. The incidence of diagnosed spontaneous miscarriages in anaesthetists' families was 10.2% of all pregnancies and it was 13.2% in paediatricians' families. Smoking seemed to increase markedly the incidence of spontaneous miscarriages, which was 22.9% in smoking female anaesthetists and 17.2% in smoking female paediatricians. The gestation times in cases of both full-term pregnancies and miscarriages were shorter in the anaesthetist group than those in the paediatrician group. Congenital abnormalities appeared at an equal rate in both anaesthetist and paediatrician groups, but strikingly, there were nine musculoskeletal abnormalities in the anaesthetists' children compared to no such defects in paediatricians' children. Serious diseases occurred at low frequencies, but three cases of hepatic jaundice and three cases of viral myocarditis in anaesthetists indicate possible infectious hazards to health in anaesthetic work. Different infectious diseases to the respiratory and urinary tracts were commonest among paediatricians. Cancer was not reported in the anaesthetist group. The study does not indicate that gas pollution in operating rooms is harmful to the personnel.
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