Der Anaesthesist
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Case Reports
[Subcutaneous abscess following long time continuous epidural anaesthesia (author's transl)].
Inflammation around the puncture canal following continuous epidural anaesthesia of short duration are observed extremely rarely. To avoid the risk of infection the catheter is kept in the epidural space for not more than 24 to 48 h in the majority of cases. ⋯ After this time, a subcutaneous abscess of cherry size had developed. Indications and contraindications are discussed on the basis of this case report.
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The main cause for the rise in cuff-pressure during anesthesia is the diffusion of nitrous oxide into the tube cuff. Gas-diffusion induced pressure changes in low pressure-high volume cuffs are registered continuously. Exposure of an air-filled cuff into an anaesthetic gas atmosphere in vitro shows, that there is an increase in cuff-pressure up to 150 mm Hg within 8 hours. ⋯ In intubated patients cuff-pressure increases even more. During anesthesia lasting 4--5 hours we recorded pressures up to 150 mm Hg, too. To prevent these high pressures we recommend the reducing of cuff-volume within defined times of anesthesia or, alternatively, the use of the anesthetic gas mixture as cuff inflating gas.