Der Anaesthesist
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Hypnosis can be an alternative to cerebral sedatives with no side effects for sedation during regional anaesthesia, especially in high-risk and fearful patients. Patients who have experience with relating techniques like Jakobson's progressive muscle relaxation are very good candidates for hypnosis. It is contraindicated in patients with psychotic disorders, major depression, and abuse of hallucinogenic drugs. ⋯ Of ten cases, hypnosis was successful in six (vegetative stress symptoms like tachycardia or shivering stopped immediately after induction of hypnosis), not completely successful in two (interruption of hypnosis after 30 min) and unsuccessful in two. Four cases where hypnosis was used during spinal anaesthesia for knee and hip surgery or brachial plexus block for open fixation of Colles' fracture are discussed as examples. As it requires more time (15 to 45 min to inform and test the patient) and special organisational conditions hypnosis will not become a routine procedure, but is still a good alternative for selected cases.
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Blood glucose alterations prior to cerebral ischaemia are associated with poor neurologic outcome, possibly due to extensive lactic acidosis or energy failure. Cerebral effects of hyper- or hypoglycaemia during cardiopulmonary resuscitation (CPR) are less well known. In addition, little information is available concerning cardiac effects of blood glucose alterations. The aim of this study was to evaluate the effects of pre-cardiac-arrest hypo- or hyper-glycaemia compared to normoglycaemia upon haemodynamics, cerebral blood flow (CBF) and metabolism (CMRO2), and regional cardiac blood flow during CPR subsequent to 3 min of cardiac and respiratory arrest and after restoration of spontaneous circulation. ⋯ Hypoglycaemia prior to cardiac arrest appears to be predictive for a poor cardiac outcome, whereas hyperglycaemia does not impair resuscitability compared to normoglycaemia. In addition, hyperglycaemia did not affect LV flow, CBF, or CMRO2. However, it has to be kept in mind that haemodynamics and organ blood flow do not permit conclusions with respect to functional neurologic recovery or histopathologic damage to the brain, which is very likely to be associated with hyperglycaemia.