Praktische Anasthesie, Wiederbelebung und Intensivtherapie最新文献

In 22 elderly patients haemodynamic alterations after epidural anaesthesia with Carticain 2% (Ultracain) with epinephrine (1:200 000) were compared to those after Lidocaine 2% with epinephrine. There were no differences to be found in these agents, and a less pronounced depressing effect of Carticain on circulation could not be confirmed. Unlike young people elderly patients only develop slight and short rises of heart rate and cardiac output after epidural anaesthesia, which are not sufficient to compensate for the distinct fall of mean arterial pressure up to the 15th minute. In our study mean arterial pressure decreased to critical values which might lead to cerebral and coronary ischemia in these patients. Adequate prophylactic and therapeutic measures are discussed.

The haemodynamics of the pulmonary and systemic circulation during anaesthesia and surgical treatment of a hip fracture were investigated in 26 patients (mean age 73 +/- 4.5 years). After induction of spinal anaesthesia the mean arterial pressure, right atrial pressure, pulmonary capillary wedge pressure and systemic vascular resistance were significantly reduced. The cardiac index remained constant due to mild tachycardia. During the operation no significant variations of the haemodynamic parameters were observed. Implantation of methylmethacrylate in 10 patients was followed by a significant increase of the mean pulmonary pressure and pulmonary vascular resistance. The PaO2 DECREASED. 15 minutes after implantation the original values were again reached.

Regional anaesthesia secured by injecting the supraclavicular plexus was used for 34 reconstructive surgical operations on the fingers and hands. The operations lasted for 5 1/2-19 hours. The advantages and disadvantages of the technique are reviewed. In 5 cases other anaesthetic techniques had to be substituted because the patients, despite sedation, could not tolerate the forced position any longer. Motivation, intensive psychic support during the operation, optimum positioning and the use of suitable sedatives are pre-conditions for the success of nerve block for prolonged surgery.

The anaesthetic requirements for peripheral angiographies in geriatric or poor risk patients are temporary sedation, analgesia and sufficient immobilisation. Neither general anaesthesia using muscle relaxants and assisted ventilation nor regional methods warrant satisfactory results in all cases, especially if multiple arteriographies are to be performed at the same session. Therefore a few new anaesthetic techniques were studied, having combined benzodiazepines with ultrashort acting intravenous narcotics. Premedication with Pethidin 1mg/kg, the administration of Flunitrazepam 0,017 mg/kg with regard to sedative, analgesic and relaxant effects and Methohexital 0.67 mg/kg as anaesthetic given prior to injection of contrast medium would seem more useful than other techniques.

In 29 patients (12 vascular and 17 trauma cases) the effect of intraabdominal bleeding and surgical management under intraoperative autotransfusion on several plasmaproteins was examined. The following parameters were monitored immediately before and after autotransfusion as well as 24, 48, 72 hours and one week later, in the thawed serum: 1. albumen and the carrier proteins prealbumen, transferrin, retinol-binding protein, 2. acute phase reactants: c-reactive protein coeruloplasmin, haptoglobin, 3. fractions of complement: C1q, C3c, C5 and C 3-activator, 4. serum-cholinesterase. With usual treatment by infusion of electrolyte solutions during operation and the following days, and further applicated blood transfusion, plasma and fresh frozen plasma by clinical needs, while the immediate blood loss during operation was replaced by autotransfusion, there was no change in preoperative dates. Only at the 3rd day the typical picture of catabolic situation of the postoperative period was observed in vascular cases and not at all in trauma cases. Thus the changes were closely related to the preexisting disease or state of shock, without further detoriation by intraoperative autotransfusion. 7 days later a sometimes overshooting normalization of the parameters was observed. Only cholinesterase remained extremely low, especially in vascular cases.

Local anaesthesia of the plexus brachialis has been performed in 821 patients within a period of two years (544 times in supraclavicular and 277 times in subaxillar technique). Effectiveness and side-effects have been evaluated on the base of objective parameters, of the findings of the anaesthetist and of the judgement of the patient. Results have been compared between individual differently experienced anaesthetist. Results demonstrate a good resp. sufficient anaesthetic effectiveness in both kinds of regional anaesthetic method, depending to some extent on the individual experience. Nevertheless complications in form of pneumothorax and lesion of the nerve happen independently of the grade of the experience of the anaesthetist. To avoid the danger of pneumothorax, the subaxillar type of plexus-brachialis-anaesthesia performed as centrally as possible, is preferred to the supraclavicular type. This technique can be recommended widely.

Buprenorphin was given to 12 patients as a postoperative analgesic after neurosurgery, and the effects of the drug on the circulation, respiration and the electroencephalogram were studied. The circulation was not significantly affected, respiration was moderately depressed, the analgesic action was satisfactory. The depression of consciousness was reflected in the electroencephalographic pattern.

Severe art. hypotensions are one of the most frequent complications of epidural anaesthesia. In 62 geriatric patients undergoing transurethral prostatic resection two methods of prophylaxis for hypotension were investigated: 1. 500ml HES before epidural anaesthesia and supine position until operation. 2. Lithotomy position immediately after EDA without plasma substitute. Blood pressure, heart rate and necessity for the application of vasoactive substances show that the lithotomy position immediately after EDA is the statistically better method. The problem of plasma substitutes in transurethral prostatic resection will be discussed.

The effect of etomidate on cerebro-spinal fluid pressure (CSFP) was investigated in 25 patients. Mean arterial blood pressure (MAP), heart rate (BPM) and blood gases were measured additionally. Cerebral perfusion pressure (CPP) was calculated from the difference MAP minus CSFP. Etomidate lowered CSFP (p less than 0,01 paired Student t-test). Ketamine-induced increase of CSFP (p less than 0,01) was normalized by etomidate. Premedication with etomidate delayed ketamine-induced increase of CSFP, which dropped to normal after a second dose of etomidate. The effect in reducing CSFP of etomidate was seen despite elevation of pCO2(p less than 0,01) in all patients breathing spontaneously.