Der Anaesthesist
-
Randomized Controlled Trial Clinical Trial
[Conduction block in man is stimulation frequency dependent].
The action of local anaesthetics on isolated nerves is enhanced by high stimulation frequencies. The aim of our study was to investigate whether high-frequency stimulation enhances regional anaesthesia in man. METHODS. ⋯ The spread of sensory block at the end of the experiments was also enhanced by stimulation with high frequencies, whereas the onset of vasomotor block (rise in skin temperature) remained unaltered. CONCLUSION. Non-oxious electrical stimulation with high frequencies significantly accelerates the onset of anaesthesia and extends the spread of sensory block.
-
Selecting a route for drug administration during CPR requires consideration of the speed with which access can be obtained, the technical difficulties involved in performing the procedure, the associated risk of complications, delays in drug delivery to the central circulation, and the duration of effective drug levels following injection. The peripheral venous route is the safest method, and drug delivery can be enhanced by a fluid bolus after injection of the medication. The circulation time is shortest after central venous injection, but there is some risk of complications. ⋯ The endotracheal tube provides an accessible route for administration of most drugs, but peak concentrations are lower than those obtained by other routes. While the results are almost the same as an intravenous injection, the intraosseous route is currently underrepresented in clinical practice. This method must not only be considered in pediatric patients, but in adult patients as well.
-
Case Reports
[Anesthesiologic aspects of pregnancy and delivery in a patient following a modified Fontan procedure ].
The number of patients with congenital cyanotic heart disease who reach child-bearing age is increasing. This is partly a consequence of the high long-term survival and the haemodynamic benefits resulting from the Fontan procedure, which is used for the definitive palliation of such cyanotic heart disease as tricuspid atresia and single ventricle. However, so far little experience has been recorded with pregnant patients who have undergone right ventricular exclusion procedures. ⋯ Impairment of venous return caused by slight caval compression or high airway pressure may reduce cardiac output more critically than in patients with a normal circulation. CONCLUSION. This case demonstrates that the haemodynamic consequences of pregnancy and of caesarean delivery under general anaesthesia can be tolerated in post-Fontan patients despite the absence of a contractile pulmonary ventricle.
-
Clinical Trial
[Insertion of a fiber optic catheter into the hepatic veins of patients with multiple organ dsfunction syndrome (MODS)].
As it is the driving force in the development of a multiorgan dysfunction syndrome (MODS), the gastro-intestinal region is at the centre of current discussion. Recently, hepatovenous oximetry has been used increasingly to monitor the relationship between oxygen supply and consumption in the splanchnic system. In the present paper we report an exclusively oximetrically controlled catheterisation procedure that can be carried out at the bedside without the use of imaging procedures. ⋯ For this reason the opening of the hepatic veins could not be recognized by a decrease in saturation using the oximetric procedure. Placement of a catheter was not possible. Future studies on larger groups of patients will be required to show to what extent monitoring of ShvO2 can lead to an efficient therapy specific for this part of the cardiovascular system in patients with sepsis and MODS.