Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2006
Review Historical Article[History and development of sonography in anesthesiology].
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2006
Use of the LMA-ProSeal in an experimental pig model -- a potential animal model for laryngeal mask airway research: results of a pilot study.
In light of the increased use of the LMA-ProSeal (P-LMA) it seems desirable to consider the P-LMA for prolonged surgical cases or post-operative ventilation. Long-term use could carry the risk of serious complications. An experimental pig model could be used to gain basic knowledge about long-term use before conducting clinical trails. In this randomized controlled study we tested the hypothesis if prolonged positive pressure ventilation (PPV) with the P-LMA in the pig is possible. ⋯ It was possible to ensure sufficient PPV with the P-LMA in the pig over different periods of time and in different body positions without any complications of airway management. The P-LMA can be used for PPV in the pig for durations of up to 390 minutes. We conclude that investigations into the long-term use of the LMA can be carried out in a pig model.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2006
[Respiratory sinus arrhythmia as predictor of blood pressure stability during anaesthetic induction in diabetics].
Diabetics with cardiovascular autonomous neuropathy (CAN) can show severe hypotension during the course of anaesthesia. To improve the safety of anaesthesia, pre-operative evaluation of this concomitant disorder is recommended. The conventional test battery described by Ewing and Clarke to diagnose CAN is relatively time-consuming and complex. The aim of this study was to evaluate whether patients at risk could be reliably identified with less diagnostic effort. ⋯ The available results prove the close connection between the pre-operatively measured breadth of respiratory sinus arrhythmia and blood pressure response during anaesthetic induction. Patients at risk of hypotension can be identified reliably and quickly during pre-operative screening with the help of a single, simple test procedure.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2006
Review Case Reports[Risks and complications of epidural neurolysis -- a review with case report].
Racz's minimal invasive epidural catheter procedure, also known as "epidural neuroplasty" is not only utilized in patients suffering from failed spine surgery ("failed back surgery syndrome") but also increasingly applied to non-surgical back pain patients to prevent chronification or deterioration. Its hypothesized principle of action is local epidural lysis of adhesions, neurolysis of vertebral nerve roots and local lavage of proinflammatory mediators by repeated injection of local anesthetics, corticosteroids, hyaluronidase and hypertonic saline solution. However adverse events are well known to occur in epidural neuroplasty. ⋯ Complications related to the procedure itself occur immediately, while complications relating to drug administration show later onset. Within this context, we report a case of severe meningitis with neurologic sequelae in a patient who received Racz catheter-treatment for unspecific low-back pain and provide an overview of the literature on other potential severe complications. As a consequence, we recommend that the Racz catheter procedure as yet should be restricted to controlled clinical trials with rigorous inclusion- and exclusion criteria.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2006
[Influence of neuromuscular blockade on the airway leak pressure of the ProSeal laryngeal mask airway].
The ProSeal laryngeal mask airway (PLMA) is increasingly used for surgical procedures that might require the intraoperative use of neuromuscular blocking agents. The airway seal of the PLMA depends on the interplay of the surrounding soft tissue of the neck and the cuff of the mask. An intraoperative neuromuscular blockade could lead to a decrease of the airway leak pressure (P (leak)) secondary to the relaxation of the muscles of the neck. With this study we tested the hypothesis that a neuromuscular blockade can result in a decreased P (leak) of the PLMA. ⋯ No general correlation between application of a neuromuscular blocking agent and a decrease of the mean P (leak) was found. However, the decrease of the P (leak) by more than 10 % in 11 % of the patients shows that in certain patients the application of neuromuscular blocking agents can result in a decreased P (leak) of the PLMA and indicates the necessity to control the P (leak) of the PLMA under complete muscle paralysis preoperatively when neuromuscular blocking agents are used.