Der Anaesthesist
-
Biography Historical Article
[Eduard C. H. von Siebold: "The use of sulfur ether vapor in obstetrics" (1847). A contribution to the beginning of modern obstetric analgesia and anesthesia in Germany].
In 1847 J. Y. Simpson in Scotland was the first to describe the administration of ether for analgesia in painful deliveries. ⋯ While he was satisfied with the good analgesia without sequelae of the new-born, he was discouraged by the termination of uterine contractions observed in all his patients. He concluded that ether was not a useful substance for analgesia during vaginal delivery, since it disturbed the natural course of labour. On the other hand, von Siebold was very pleased with the administration of ether for operative obstetric procedures such as forceps deliveries or placental retention.
-
Partial liquid ventilation (PLV) is a relatively new therapeutic approach to acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). The idea of combining the intrapulmonary application of an oxygen-carrying substance and positive pressure ventilation was introduced by Fuhrman in 1991 and originally called perfluorocarbon-associated gas exchange (PAGE). Nowadays, the technique is mostly known as partial liquid ventilation (PLV). ⋯ However, combination therapy is still experimental and further investigation is necessary to evaluate efficacy and potential risks. Many questions still exist which need to be answered by experimental as well as human pilot studies. Based on these studies, the results of ongoing human trials can be assessed properly and new multicenter trials can be planned effectively.
-
Randomized Controlled Trial Clinical Trial
[Prevention of intraoperative hypothermia in children].
Children are very sensible to the occurrence of intraoperative hypothermia (HT) (core temperature < or = 36.0 degrees C) during general anaesthesia because their regulation capacity is less effective than in adults and due to a large skin-surface area compared with their body mass. We compared the efficacy of different heating devices to prevent HT in children during surgery. ⋯ OR temperature seems to be a critical factor influencing heat loss. Increasing OR temperature and covering with cotton sheets was not effective in preventing the heat loss. Increasing room temperature in combination with aluminum sheets is one alternative to prevent HT. Our study shows that the use of a convective warming device prevents HT during a 2-hour surgery in young children even at a OR temperature of about 22 degrees C. In conclusion, in pediatric patients the use of a convective heating system proved to be an effective alternative to room heating.
-
This review highlights the advantages of regional anaesthesia techniques, especially of epidural analgesia, for the management of postoperative and posttraumatic pain: excellent pain relief and a high degree of patient satisfaction, even compared to the gold standard of acute pain therapy, i.v. PCA with opioids. Further advantages of epidural analgesia (EA) are discussed, such as early recovery of gastrointestinal function, reduction of postoperative respiratory complications, lower incidence of myocardial ischema, better mobilisation, reduced risk of thromboembolism, lower incidence of chronic pain problems (such as phantom limb pain) etc. ⋯ Organisational structures (such as an acute pain service) and appropriate monitoring allow to continue EA with local anaesthetics and/or opioids on surgical wards. Recommendations are given for the monitoring of EA on surgical wards. Clear cut agreements should define the role of anaesthesiologists, surgeons and nurses in the management of patients treated with postoperative EA on surgical wards.