Section 16: Abdominal surgery Mark C Bellamy
Brian Pollard in Handbook of Clinical Anaesthesia 3E, 2011
Anaesthesia for abdominal surgery embraces a wide range of disciplines. In many cases, the technique of choice involves general anaesthesia, perhaps in combination with thoracic epidural anaesthesia for postoperative pain relief. Not all intra-abdominal procedures necessitate general anaesthesia. Those confi ned to the pelvis are frequently carried out under spinal anaesthesia or epidural blockade. Some body surface procedures are adequately carried out using local nerve blocks or infi ltration anaesthesia. Inguinal hernia repair falls into this category. Much lower abdominal surgery is performed under a regional block alone – spinal or combined epidural-spinal anaesthesia – or using a regional technique as an adjunct to light general anaesthesia. The more widespread availability of highquality bedside ultrasound has encouraged increasing use of both single-shot and continuous catheter regional blocks as an alternative to the thoracic epidural. The transversus abdominis plane (TAP) block has emerged as the leading technique in this group, although rectus sheath and other blocks also have a role.
General anaesthesia and acid aspiration
Philip Steer, Gwyneth Lewis in Crises in Childbirth Why Mothers Survive, 2018
General anaesthesia predisposes women to gastric acid aspiration. Prevention and management of aspiration are fundamental in reducing deaths associated with aspiration. The dramatic reduction in cases of aspiration since the initiation of the Confidential Enquiries into Maternal Deaths (CEMD) reports has been secondary to changes in prophylactic antacid measures and the increased use of regional anaesthesia. Many investigators have tried to elucidate the true incidence of morbidity and mortality related to aspiration in obstetric anaesthesia. The CEMD triennial reports have shown a steady decline in the numbers of deaths related to pulmonary aspiration, with 18 deaths in 1964–66, 11 deaths in 1976–78, and 1 death each in 1991–93 and 2000–2002. Management of aspiration has been primarily aimed at prevention. This includes fasting patients, pharmacotherapy, physical factors and modulation of the anaesthetic technique. Successive CEMD reports have done much to stimulate improvements in clinical practice that have decreased the incidence of and mortality due to aspiration of gastric contents.
Recovery, handover and protocols
Peter Nightingale in Anaesthetics for Junior Doctors and Allied Professionals, 2018
The anaesthetist should transfer the patient from the theatre to the recovery room ensuring adequate monitoring and support. Following the transfer of the patient to the recovery room, good handover and clear instructions to the recovery staff responsible for the patient helps predict and avoid common problems encountered in the recovery room. Many problems that arise in the recovery room can be anticipated based on the patient's co-morbidities, the surgical procedure and the intra-operative course. Post-operative nausea and vomiting is a common problem following general anaesthesia, and it may also result from hypotension following spinal and epidural anaesthesia. Post-operative shivering is commonly observed as a result of hypothermia following heat loss during anaesthesia. The discharge of the patient from the recovery unit is the prime responsibility of the anaesthetist, but surgical considerations might mean that the responsibility is shared with the surgeon.
Sedation versus general anaesthesia in paediatric patients undergoing chest ct
Published in Acta Radiologica, 1998
W. W. M. Lam, P. P. Chen, N. M. C. So, C. Metreweli
Objective: CT of the chest in paediatric patients often requires sedation or general anaesthesia to minimize motion artefacts. Both sedation and general anaesthesia are associated with atelectasis which obscures the underlying pulmonary pathology. We conducted a prospective study to compare these two methods with respect to degree of motion artefacts and extent of atelectasis Material and Methods: Nineteen patients undergoing 22 chest CT examinations were randomly selected for either sedation or general anaesthesia. The total area of atelectasis and the degree of motion artefacts were measured Results: The mean percentage of atelectasis was 6.67% for general anaesthesia and 0.01% for sedation (p=0.01). There was no significant difference in the quality of the images between the sedation patients and the general anaesthesia patients Conclusion: Whenever the clinical condition permits it, sedation rather than general anaesthesia should be given to paediatric patients undergoing chest CT
General anaesthesia with and without intubation for patients with Cornelia de Lange syndrome
Published in Southern African Journal of Anaesthesia and Analgesia, 2009
Y Asahi, I Tsujimoto, Y Kawai, M Sugimoto, T Suzuki, S Omichi, M Kogo, J Kotani
ABSTRACT We present the use of different methods of general anaesthesia in two patients with Cornelia de Lange syndrome and its contribution to the patients' oral health. Case 1: The patient was a 22-year-old woman with Cornelia de Lange syndrome who underwent dental treatment under general anaesthesia. She exhibited the physical characteristics of Cornelia de Lange syndrome, including a small mouth, thin lips, short limbs, stiffness of joints and intellectual disability. General anaesthesia without intubation was performed safely eight times. No other complications except hypersensitivity to hypnotic agents were observed. Case 2: The patient was a 10-year-old boy with Cornelia de Lange syndrome who underwent dental treatment under general anaesthesia. He had a history and symptoms of obstructive airway disorders in addition to showing physical characteristics of the syndrome similar to those seen in Case 1. General anaesthesia with nasal intubation was performed safely twice. Computed tomography (CT) of his head and neck produced unremarkable results. These cases demonstrate that both general anaesthesia with and without nasal intubation can be safely used in managing individuals with Cornelia de Lange syndrome during dental treatment.
Effect of General and Local Anaesthesia on Blood Loss During and after Therapeutic Abortion
Published in Acta Obstetricia et Gynecologica Scandinavica, 1978
Birger R. Møller, Jørgen Trier Hansen, Søren Mommsen
The blood loss occurring during therapeutic abortion performed under local and general anaesthesia and the postoperative bleeding was measured in 60 healthy women in the first trimester of pregnancy. The patients were 20-30 years old (mean age 24.3 years), all being nulliparae. They were divided into three equal groups according to the duration of pregnancy. In each group, 10 patients underwent abortion under general anaesthesia, and the remaining 10 under local anaesthesia. In all cases, cervical dilatation by the Hegar method and vacuum aspiration were used, and all operations were performed by the same surgeon. General anaesthesia was induced with atropine and thiopental and maintained with inhalation of a 2:1 mixture of nitrous oxide and oxygen and small doses of thiopental and pethidine. Local anaesthesia consisted in paracervical blockade produced by injection of 1 % lidocaine-adrenaline. The blood loss (Table I) was smallest in the 7th and 8th weeks of pregnancy under both local and general anaesthesia and increased with the gestational age. In all three groups, the blood loss during operation under general anaesthesia was nearly twice as large as under local anaesthesia. There was no difference in the postoperative bleeding under local and general anaesthesia. It is concluded that local anaesthesia has several advantages. Paracervical blockade provides a rapid and reliable anaesthesia which is adequate for most patients. The costs, delays and complications of general anaesthesia are avoided. Local anaesthesia is well suited for out-patients, and the blood loss is reduced to a minimum.
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