Der Anaesthesist
-
This special article for continued education begins with a broad definition of septic shock. The following section describes the fundamental organ dysfunctions and pathomechanisms. ⋯ The specific therapeutic interventions (only those which have been proven effective and recommendable for routine clinical use) will be presented. Monitoring of infection and organ function are discussed briefly.
-
Many neurosurgeons prefer the sitting position for patients undergoing surgery in the posterior fossa because of the easier access and better conditions for haemostasis. Pneumatocephalus is a possible consequence of surgery in the posterior fossa with the patient in the sitting position. When this occurs air may enter the subarachnoid space, the cisternae, the ventricular system or the subdural space; it becomes more likely when any of the following is/are present: loss of CSF, a large cavity resulting from surgery, external or internal drainage of CSF, osmotic diuresis, and hyperventilation. ⋯ As complete skin had already been closure no explanation for the air embolism could be found. The patient was positioned supine, and air was no longer detectable in the right heart after 1 min. Approximately 1 h later both pupils were dilated and unreactive to light.(ABSTRACT TRUNCATED AT 250 WORDS)
-
In the postoperative period patients are at risk of excessive oxygen consumption (VO2). However, patients suffering from cardiovascular disease may be unable to increase their oxygen transport capacity sufficiently and may be especially vulnerable to tissue hypoxia as part of the reaction to intraoperative stress. During the last 10 years conflicting results concerning the benefits of a combined epidural and light general anaesthesia have been published. ⋯ In the early postoperative period (5 min) patients in group 1 showed a VO2 or 3.6 +/- 0.4 ml.kg-1.min-1. This was the same as in group 3 (3.5 +/- 0.3 ml.kg-1.min-1). In contrast, in group 2 a VO2 of 5.3 +/- 0.7 ml.kg-1.min-1