The unfavourable effects of prolonged anaesthesia

Perioperative Challenges in Repeat Bladder Exstrophy Repair - Case Report

Bladder exstrophy is a rare congenital malformation. It presents as leakage of urine in the anterior abdominal wall following defects in midline anterior abdominal wall skin and bladder. We report the use of combined general anaesthesia and caudal epidural analgesia in a 4yr old boy for repeat bladder exstrophy repair. Problems of prolonged surgery and the challenges of pain and sedation management in the post operative period are discussed.

Preoperative screening

In screening the preoperative patient, several sources of risk, each with potentially modifiable components, must be considered. These include risks related to the proposed procedure, anesthetic, and medical illnesses present in the patient. To screen effectively, one must look for potential factors in each area that may affect perioperative morbidity and mortality. Once risk areas are identified, it is helpful to quantify them further through a focused testing approach, especially when the anticipated surgical or anesthetic risks are high. Data obtained through this process should guide the optimization of the patient's medical status to modify risks when possible. Sharing information obtained during the preoperative assessment with both anesthesiologists and surgeons helps to refine plans for management and may better ensure patient safety in the perioperative period.

Potential toxicity from prolonged anesthesia: a case report of a thirty-hour anesthetic

Selection of anesthetics for prolonged administration must include consideration of potential toxicity resulting from extended exposure. This report deals with a patient undergoing a 30-hour anesthetic that included nitrous oxide (N2O) and isoflurane (9.7 MAC-hours). Serial serum inorganic fluoride levels obtained in the perioperative period demonstrated a peak fluoride level of 12.6 mumols occurring 27 hours after isoflurane was discontinued. Although higher than previously reported fluoride levels following isoflurane anesthesia in healthy adults (4 mumols), the current results are below those levels associated with renal abnormalities after prolonged enflurane anesthesia (34 mumols). In addition to outlining basic care guidelines for patients undergoing a prolonged anesthetic, this report discusses potential toxicity from prolonged exposure to both N2O and isoflurane. It concludes that isoflurane can be tolerated in doses up to 10 MAC-hours without fluoride toxicity but cautions against the use of N2O for periods longer than 24 hours.

Mortality following surgery for fractures of the neck of femur

The mortality following surgery for hip fractures during 1982 is reviewed. 91 procedures were performed on 89 patients. The mortality rate at 4 weeks following general anaesthesia was 2.7%. This is much lower than previously reported. Possible reasons for the variation in mortality between this series and others, are discussed.