Praktische Anasthesie, Wiederbelebung und Intensivtherapie最新文献

One of the indications for chest radiography in intensive care units is the diagnosis for mishaps or sequelae arising, e.g., from failure to insert a central venous catheter, wrong position of the catheter, a too deeply inserted tracheal tube, a wrongly sited gastric catheter; also to find the causes of, e.g., lack of stimulation by a pacemaker or ineffective thorax drainage. Success in this type of diagnostic radiography presupposes a competent technique, radiopaque catheter material and a thorough acquaintance on the part of the radiologist with the procedures employed in intensive care. Abb. 7 a.

Misinterpretation of chest roentgenograms in intensive care patients can be largely obviated by a skilled technique and a thorough knowledge on the part of the radiologist of the structural changes in the lungs and their differential diagnostic significance. Correct interpretation is facilitated by relating the observed changes to the pathophysiological clinical findings.

Unlabelled: A method of spinal anaesthesia with Dixidextracaine-70 (a mixture of xylocaine 40.0 mg + percaine, 10.0 mg+ Dextran-70, 60,0 mg+ distiled water ad 2.0 ml) with continuous epidural block has been tested in 150 patients. The advantages of this association are: the possibility of obtaining a high quality conduction anaesthesia, virtually unlimited in time, the ability to extend over several anatomical regions the surgical field, minimal toxicity, the absence of postoperative pulmonary complications, and the economy. Drawbacks are: the need for two vertebral punctures, the longer induction time of anaesthesia and some difficulty in finding the subarachnoid space after catheterisation of the epidural space. The indications of the method include subdiaphragmatic surgery, interventions on more than one anatomical region, surgery in aging patients, patients with full stomach, and those with anaesthetic and surgical risk, as well as socioeconomic factors which may prevent application of a differentiated and safe narcosis.

Contraindications: those of subarachnoid and epidural block. The incidents and accidents are minimal and specific to both techniques. The fear of producing total subarachnoid anaesthesia by injection of the anaesthetic solution in the epidural space after puncture of the subarachnoid space is virtually unfounded.

Since 1972 electrostimulation anaesthesia (ESA) has been employed in an attempt to reduce the amount of anaesthetic agents needed. In the beginning the Chinese combination of acupuncture points was used; at a later stage Benzer et al. inserted the needles paravertebrally and Abdulla replaced the needles by contact electrodes for ophthalmic operations. At the Department of Anaesthetics, Hamburg, the same course was followed, i.e. the classic acupuncture points were used originally, then the acupuncture points were used originally, then the technique was changed to paravertebral insertion of the needles and now only paravertebrally placed contact electrodes are being employed for inducing ESA for various surgical operations. All three techniques of ESA have proved satisfactory; but ESA with contact electrodes is considered the method of choice on account of both practical considerations and success rate.

Central venous pressure was measured in 34 persons who had transurethral prostatectomy in general or regional anaesthesia. The aim of the investigation was to ascertain to what extent measurement of the central venous pressure as a parameter of blood volume can help towards the early diagnosis of hypervolaemia caused by the leakage of irrigation fluid into the patient's circulation. During general anaesthesia blood pressure and central venous pressure reached their maximum 10 minutes later and were significantly higher than was the case in regional anaesthesia. For detecting and preventing dangerous hypervolaemia during transurethral prostatectomy in general anaesthesia routine recording of the central venous pressure is recommended. The less severe reaction during regional anaesthesia on the circulation is probably attributable to a sympathicolytic effect and peripheral pooling. The early detection of the leakage syndrome is easier in the conscious patient.

In Germany electrostimulation anaesthesia (ESA) has, so far, not been considered suitable for surgical operations on the extremities. An attempt was made to develop a combination of acupuncture points that would allow the use of ESA for this type of surgery. Based on the experience gained with ESA in abdominal surgery the suitability of paravertebral contact electrodes for operations on the limb was studied. Because of its simplicity and efficacy this technique of ESA is highly recommended.

The stimulating impulses employed in electroacupuncture analgesia are of widely differing character and strength. Experiences with the Chinese impulse generator MPTA 71-3 clearly show the necessity to determine the performance of the generator and to measure and record the strength, configuration and frequency of the electrical impulses employed. A simple equipment for measuring these factors is described. The apparatus makes it possible to record the character and type of the stimuli and to compare different techniques of stimulation.

In 32 patients between 53 and 86 years of age, undergoing transurethral prostatectomy, the influence of intraoperative sedation with Diazepam (5-10 mg) and Flunitrazepam (0,4-0,8 mg) on postoperative forced vital capacity, forced exspiratory volume (1 sec.) and peakflow, were measured, compared to placebo. We could not find a depression of these ventilatory parameters, in the three groups except peak-flow after sedation with Flunitrazepam in the evening after operation (p less than or equal to 0,05). We conclude that sedation during regional anesthesia does not impair the most important advantage of local anesthesia, the minor effect on ventilation, compared with general anesthesia.

The sedative, hypnotic and amnesic effects of flunitrazepam, a new benzodiazepine, were tested in doses of 0 (placebo), 0,4 mg and 0,8 mg. These doses were sufficient to produce a satisfying sedative effect on patients, being operated on in regional anaesthesia. In few cases we found undesirable effects. Positive and negative aspects of amnesia will be discussed.