Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Micturition disorders following spinal anesthesia of different durations of action (lidocaine 2% versus bupivacaine 0.5%)].
Disturbances of micturition following spinal anaesthesia are considered to be rare and harmless side effects of this technique. For this reason, we set up a prospective study to investigate their incidence, characteristics and intensity. Our special interest was directed at the influence of the duration of action of local anaesthetics. ⋯ Their higher frequency following the longer acting bupivacaine may be evidence of longer lasting blockade of the efferent sacral parasympathetic fibers innervating the detrusor vesicae muscle, leading to inhibition of bladder voiding. The consequences of these disturbances, if not correctly managed, may be distension of the urinary bladder with ensuing infection and loss of tone of the detrusor muscle. Various measures are recommended: choice of the longer acting local anaesthetic only if necessary, careful control of bladder filling, restrictive infusion of fluids, early mobilization, carbachol, catheterization in good time, prophylactic placement of an indwelling catheter in patients with previous disturbances.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Does an injection filter modify the cranial spread of a sensory blockade in epidural anesthesia?].
In a prospective study we compared the spread of sensory blockade in epidural anaesthesia with and without Micropore filter. ⋯ A total of 32 patients undergoing varicose vein stripping under epidural anaesthesia were randomly assigned to two groups of 16 each. Bupivacaine 0.75% and POR 8 (0.1 IU/ml) were administered by means of a constant-velocity perfusor. In group A a Micropore filter was inserted between the perfusor syringe and the epidural catheter. In group B the epidural catheter was connected to the syringe without the filter. The puncture was performed at the L3-4 interspace with the patient in a sitting position. An epidural catheter was advanced 3 cm cephalad. Using the pin-prick method, the sensory level of the blockade was tested 5, 7, 10, 15, 20 and 30 min after injection of the local anesthetic solution. Statistical evaluation was performed with the t-test for unpaired samples. RESULTS. After 10 min the spread of analgesia was 5.75 +/- 1.26 segments in group A and 8 +/- 1.89 segments in group B; after 15 min it was 7.06 +/- 1.62 segments and 9.56 +/- 1.54 segments; after 20 min, 7.87 +/- 1.62 segments and 10.62 +/- 1.45 segments; and after 30 min 8.12 +/- 1.66 segments and 11.12 +/- 1.45 segments in group A and B, respectively. At any time sensory blockade was higher in group B (without Micropore filters) than in group A. The mean difference between the two groups amounted to 2-3 segments. The differences were significant at any time (P less than 0.001). These results show that the use of a Micropore filter in epidural anaesthesia leads to a reduced spread of sensory blockade. In our own examinations we found lowering of the pressure of the local anaesthetic solution that passes through the Micropore filter compared with the pressure of the solution injected without the filter. This seems to be the reason for the reduced spread of sensory blockade. Using these filters the onset of analgesia is delayed, and a given spread of analgesia needs a larger dose of local anaesthetic and is thus accompanied by a higher toxicity.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cognitive and psychomotor performance following isoflurane, midazolam/alfentanil and propofol anesthesia. A comparative study].
Mental and psychomotor abilities are impaired to varying degrees after general anaesthesia. This has important implications for the time over which patients are monitored in the recovery room and for the discharge of outpatients after day surgery. The present study was undertaken to compare recovery and mental and psychomotor skills in the first 60 min following general anaesthesia with isoflurane, midazolam/alfentanil and propofol. ⋯ The results indicate that in operations of approximately 90 min duration the return of motor and mental abilities is faster following propofol anaesthesia. At 30 min after extubation following propofol anaesthesia patients had test results that allow their transfer from the recovery room, while it took 60 min for patients in the two other groups to reach the same levels of motor and mental function. This is important for the duration of monitoring in the recovery room and, especially, for day case anaesthesia.
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Randomized Controlled Trial Clinical Trial
[The use of propofol during diskectomy in neurosurgery].
The intravenous anaesthetic agent propofol has become more and more popular not only for induction but also for the maintenance of anaesthesia in all fields of surgery. For this purpose, different infusion rates and also combinations of propofol with opioids, nitrous oxide and volatile anaesthetic agents have been described. The present study was designed to find the best dosage regimen for short operations and rapid changes. ⋯ An additional administration of fentanyl can prevent hypertensive reactions or tachycardia with intubation, but on the other hand fentanyl can also increase the cardial depression of propofol with a dangerous decrease in blood pressure and heart rate. Therefore in combination with opioids lower doses of propofol should be used for induction and maintenance of anaesthesia. If opioids are administered, signs of a residual postoperative respiratory depression have to be taken seriously.
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The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. There are several disadvantages of the standard Magill forceps; however: the danger of cuff perforation, the necessity of readjusting the forceps when placing a tube or catheter, and the risk of injury to the mucous membrane. For these reasons the standard Magill forceps have been modified: the jaws of the forceps have been changed to give curved atraumatic parts without any serrations or sharp edges. ⋯ The resulting benefits are as follows: Reduced risk of injuring the mucous membrane and perforating the cuff. Tubes and catheter are safely guided between the semiround jaws, making it unnecessary to open the forceps repeatedly to advance the tube. Tampons being placed in the throat no longer get caught between the serrations, and even small foreign objects can easily be extracted from the pharynx.