Der Anaesthesist
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In order to obtain figures on the anaesthesia related maternal mortality in the Federal Republic of Germany, 707 hospitals have been addressed via questionnaire. Hospitals where obstetric departments and anaesthetic departments as well were available, were investigated for maternal mortality, anaesthetic requirements, and the complications which led to the maternal deaths during the period of 1971-1980. 38% (259 general hospitals and 10 university hospitals) responded; the geographical distribution seemed to be representative. The average maternal mortality rate was at 0.21%, which ranged from 0.21% for general hospitals to 0.16% for university hospitals. ⋯ The main complications which led to the maternal deaths were cardiac arrest and aspiration of gastric content with 38,1% each and convulsions with 4.8%. In 19% of the total maternal deaths the causes could not be determined. The importance of obstetric centres and of controlled anaesthetic methods delivery will be discussed on the basis of these and other figures which have been reported in the literature.
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Since the precise measurement of halothane-concentration in the patients gas support during routine anesthesia still requires much effort, the accuracy of the vaporizers halothane output remains important for the safety of anesthesia and the education of younger anesthesiologists. In the present study 30 halothane vaporizers (14 Fluotec Mark 3/Cyprane Ltd., 12 Vapor 19/Dräger, 4 Abingdon/Penlon) were removed from the operating rooms in the University Hospital Göttingen to test their accuracy. The measurements were performed with a masspectrometer under standardized laboratory conditions with varied temperatures (10 degrees, 21 degrees, 35 degrees C), gasflows (3, 5, 8 l/min) and compositions of carrier gas (100% O2, N2O/O2 = 2/1). ⋯ The Fluotec Mark 3 vaporizers output depended on the temperature and gasflow but was almost unaffected by the carrier gas composition. Tremendous deviations appeared with the Abingdon vaporizers, which seamed to be without any temperature compensation and which were highly gas flow dependent. It can be concluded from our results that vaporizers according to their construction tend to be imprecise.
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Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (each 20 having undergone abdominal or orthopaedic operations). Morphine boluses each of 1.92 mg were available via a hand-button whenever the patients felt pain relief necessary, and delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). ⋯ With respect to different anaesthetic techniques, patients recovering from spinal anaesthesia needed lower morphine doses only during the first few (1-4) h in comparison with neuroleptanalgesia. Over-all efficacy and patient acceptance proved to be excellent. Effectiveness of PCA was judged superior by about 84% of patients when compared with previously experienced conventional postoperative analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)