Der Anaesthesist
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The number of older persons who have to undergo surgical procedures is steadily growing. For these patients the risks of anaesthesia are often increased because of their past medical history and their restricted physiological resources. Apart from parameters of the cardiovascular system, the electroencephalogram (EEG) represents a supplementary method for intraoperative monitoring, because cerebral alterations caused by anaesthetics or narcotics are directly reflected in the EEG. ⋯ Furthermore, geriatric patients show a reduced need for narcotic agents. However, the variation of the required dosage is greater in older than in younger persons. The results of the present study show that with regard to an automatic classification of the EEG during anaesthesia, alterations of the EEG with age have to be taken into account.
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We have studied mid-latency auditory evoked potentials (MLAEP) during general anaesthesia with sufentanil in ten patients scheduled for elective major urological surgery. Anaesthesia was induced with sufentanil 2-3 micrograms/kg; for maintenance of anaesthesia a further bolus of sufentanil (1-2 micrograms/kg) 10 min before the start of surgery (skin incision) was given. MLAEP were recorded before and 10 min after the last sufentanil bolus on the vertex (positive) and mastoids on both sides (negative). Latencies of the peaks V, Na, Pa, Nb, and Pl (ms) and amplitudes Na/Pa, Pa/Nb, and Nb/Pl (microV) were measured. ⋯ There is no substantial difference of sufentanil's effect on MLAEP compared with the opioids alfentanil, fentanyl, and morphine. Because Na, Pa, and Nb are generated in the primary auditory cortex of the temporal lobe, it must be concluded that during general anaesthesia with sufentanil primary cortical processing of auditory stimuli may be preserved.
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Friedreich's disease is a very rare neurological disorder that causes degeneration of the posterior roots of the spinal nerves and progresses to the anterior roots, even in young adults. Hospital emergency teams face the question of choice of anaesthesia in such patients should general anaesthesia be preferred to regional anaesthesia. We report a 36-year-old patient with spinocerebellar heredoataxia (Friedreich's disease) who underwent a proctological procedure after administration of spinal anaesthesia with 3 mg hyperbaric bupivacaine in a sitting position. Both the intra- and post-operative courses were unremarkable; in particular, with regard to the underlying neurological disease, no complications were observed.