Assuntos
Anestesia/efeitos adversos , Anestésicos/efeitos adversos , Hiperóxia/etiologia , Deficiências da Aprendizagem/etiologia , Criança , Transtornos do Comportamento Infantil/induzido quimicamente , Transtornos do Comportamento Infantil/etiologia , Humanos , Hiperóxia/psicologia , Deficiências da Aprendizagem/epidemiologia , Deficiências da Aprendizagem/psicologia , Estresse OxidativoRESUMO
UNLABELLED: In this study, we examined the emergence characteristics of children tracheally extubated while deeply anesthetized with desflurane (Group D) or sevoflurane (Group S). Forty-eight children were randomly assigned to one of the two groups. At the end of the operation, all subjects were tracheally extubated while breathing 1.5 times the minimal effective concentration of assigned inhaled anesthetic. Recovery characteristics and complications were noted. Group D patients had higher arousal scores on arrival to the postanesthesia care unit than Group S patients. Later arousal scores were not significantly different. No serious complications occurred in either group. Coughing episodes and the overall incidence of complications after extubation were more frequent in Group D. Readiness for discharge and actual time to discharge were not significantly different between groups. Emergence agitation was common in both groups (33% overall, 46% for Group D, and 21% for Group S). Narcotic administration in the postanesthesia care unit occurred more frequently in Group D (10 of 24 patients) versus Group S (3 of 24 patients). Premedication with oral midazolam resulted in significantly longer emergence times regardless of the potent inhaled anesthetic administered. IMPLICATIONS: Deep extubation of children can be performed safely with desflurane or sevoflurane. Airway problems occur more frequently with desflurane. Awakening occurs more quickly with desflurane. Midazolam premedication has a greater effect on emergence times than does the choice of inhaled anesthetic. Emergence agitation occurs frequently with either technique.
Assuntos
Anestesia por Inalação , Anestésicos Inalatórios , Intubação Intratraqueal , Isoflurano , Isoflurano/análogos & derivados , Éteres Metílicos , Adolescente , Período de Recuperação da Anestesia , Anestesia por Inalação/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Nível de Alerta , Criança , Pré-Escolar , Desflurano , Feminino , Humanos , Lactente , Intubação Intratraqueal/efeitos adversos , Isoflurano/efeitos adversos , Laringismo/epidemiologia , Laringismo/etiologia , Masculino , Éteres Metílicos/efeitos adversos , Náusea e Vômito Pós-Operatórios/epidemiologia , Medicação Pré-Anestésica , SevofluranoRESUMO
Communication in medicine deserves greater attention than it usually receives. The physician's obligation to obtain informed consent for clinical care and research forces the issue out into the open. Recognition that communication can have legal and economic impacts suggests communication skills should be cultivated as a medical art. This review places communication issues in anesthesia practice, especially those related to informed consent, in an historical, and when possible, scientific context.
