Der Anaesthesist
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Clinical Trial
[Patient-controlled postoperative epidural analgesia. Prospective study of 1799 patients].
Side effects of postoperative epidural analgesia can be controlled by two strategies: Insertion of catheters into the center of the affected spinal segments and coadministration of local anesthetics and opioids. Both techniques will reduce single drug dosage. Additionally synergistic effects will result in excellent analgesia and the risk of side effects and complications will be minimized. ⋯ Mean VAS-scores during the postoperative observation-period were within the prior defined limits. On the morning after surgery, however, a reduction in pain relief was observed and analgesia on the first postoperative day could significantly be improved after a 24-h on call pain service has been introduced. Except urinary retention side effects are rare. Probability of motor-blockade is significantly lower in patients with thoracic compared to patients with lumbar catheters. Not any patient suffered from severe complications such as sedation or respiratory depression.de
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Pheochromocytomas are functionally active, catecholamine-secreting tumours of chromaffin tissue. The mainstay of pharmacological therapy is preoperative treatment with oral phenoxybenzamine. This drug irreversibly alkylates alpha-1-adrenergic receptors on vascular smooth muscle and renders them nonfunctional, thereby causing vasodilatation. ⋯ After complete resection of a total of three tumours, no further hypertensive crises occurred. The patient's postoperative course was uneventful. We conclude that in this patient presenting with an unsuspected multilocular pheochromocytoma, the lack of permanent alpha-blockade was probably helpful in allowing complete resection of all the tumours.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Intravenous versus thoracic-epidural patient-controlled analgesia following extended abdominal or thoracic surgery].
Intravenous patient-controlled analgesia (PCA-i.v.) has has markedly improved postoperative pain-relief. Alternatively, peridural anesthesia has been used successfully in high risk patients with the disadvantage of a more intense postoperative care. In this study we compared the applicability of intravenous vs. peridural patient-controlled analgesia on a general ward. ⋯ This study demonstrates that epidural PCA can be used on a general surgical ward as an alternative method compared to intravenous PCA. PCA-PDK may be advantageous over intravenous PCA since both techniques require similar intense monitoring and side effects in the PCA-PDK group appear to be less.
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Effects of anaesthesia and analgesia on postoperative morbidity and mortality remain controversial. Numerous studies have demonstrated that epidural anaesthesia and pain relief by epidural analgesia reduces perioperative stress responses and thus may reduce postoperative morbidity and mortality. In patients undergoing vascular surgery, epidural anaesthesia diminished postoperative hypercoagulability. ⋯ One reason for this disappointing finding may be the missing integration of improved postoperative pain relief into general surgical care. A multimodal therapeutic approach, which consists of preoperative patient information, sufficient analgesia, early mobilisation and enteral feeding, may solve this discrepancy. Therefore, prospective controlled studies are needed to assess the influence of this perioperative approach on outcome.
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Postoperative neurological sequelae in patients that have received epidural anaesthesia are not necessarily caused by the epidural anaesthetic technique. As a whole, adverse neurological outcomes following epidural anaesthesia may be subdivided into 3 different ethiological categories. A first category involves events that are not at all caused by the epidural, but merely due to the interference of anaesthesia and/or surgery with a preexisting medical condition. ⋯ These complications include some of the most dramatic sequelae of major neuraxial blockade, such as spinal epidural abscess, spinal infarction, and spinal hematoma. Although extremely rare, the latter complications often result in permanent major neurological deficits. The present manuscript is a review of the most recent, literature addressing post-anaesthetic sequelae, and will discuss their incidence, pathophysiology, clinical course, diagnosis, prevention, and treatment.