Marc R. Raffe

Anesthetic Management of Thoracotomy

Successful anesthesia for thoracic surgery requires an understanding of the clinical disease and the physiologic changes accompanying the disease, as well as anesthetic agents available for use. The authors discuss selection of appropriate anesthetic drugs, perioperative management considerations, pharmacologic support, intraoperative monitoring and postoperative pain management.

Anesthesia for Severe Liver Dysfunction

By using these guidelines, we have safely anesthetized high-risk liver patients with minimal complications. By understanding the consequences of the underlying disease, prudent selection of agents that use alternate methods of excretion, careful perioperative support and management, and close observation during the postoperative period, the liver disease patient may be safely anesthetized with minimal complications.

The case for routine fluid administration.

Because the risks associated with fluid administration are small, but the effects of fluid withdrawal during anesthesia can be significant, routine fluids should be considered in all cases in which general anesthesia exceeds 45 minutes.

The case for qualitative anesthesia.

Qualitative anesthesia is an effective, time-honored, familiar, and simple technique for maintaining general anesthesia. There is no reason to change.

Precautions when using opioid agonist-antagonist analgesics.

Agonist-antagonists are attractive because of their availability and absence of strict regulation. They do provide effective analgesia in many cases, and they are cost-effective. Incomplete analgesia can be noted in moderate to severe pain. Cardiopulmonary depression may be noted following agonist-antagonist administration. Interference with coadministered opiate agents may occur.