Der Anaesthesist
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Innate and acquired immunity plays a pivotal role in the host defense response. Pain, stress, necrotic tissue and invading microorganisms are known modulators of the complex immune response of patients undergoing major surgery. Anaesthesia itself or perioperative interventions of the anaesthesiologist may substantially alter the immune function with potential impact on the postoperative course. ⋯ However, these actions may only be apparent with high or supraclinical concentrations and/or long-term exposure. Regarding the latter, evidence suggests that long-term sedation using thiopentone in neurosurgical patients is paralleled by infectious complications in a dose-dependent manner. At present, no data are available regarding the significance of the observed alterations associated with various anaesthetic procedures of the incidence of postoperative complications associated with impaired immunity, such as infection or metastatic spreading in oncological surgery.
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Goal of this survey is to give an overview of anaesthesia for caesarean section in Germany. ⋯ General anaesthesia is the commonest practice for caesarean sections at German hospitals. Nowadays regional anaesthesia gains more importance compared to previous German surveys and in agreement with foreign data.
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Randomized Controlled Trial Clinical Trial
[Dose-response relationship of clonidine with epidural administration of ropivacaine in orthopedic procedures of the lower extremities].
The aim of this study was to investigate preliminarydose-range effects of clonidine added to ropivacaine for epidural analgesia in elective orthopedic surgery of the lower limbs with doses, causing a minimum of cardiovascular side effects. ⋯ We conclude that 150 micrograms clonidine significantly enhances the duration of analgesia of epidurally administered ropivacaine in a mean of 171 mg. This time interval is longer than the one with 200 mg ropivacaine alone. But, there are side effects in form of decrease of arterial pressure. Cardiovascular monitoring seems to be essential. Because of the enhanced analgesia duration, the time interval for reloading epidural anaesthesia are increased.
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Clinical Trial Controlled Clinical Trial
[Vertical infraclavicular brachial-plexus blockade. A clinical study of reliability of a new method for plexus anesthesia of the upper extremity].
We examined the efficacy of the vertical infraclavicular block for plexus brachialis anaesthesia using a nerve stimulator after introducing the method (VIP1) and after three years of clinical experience (VIP2). In two prospective studies we compared the results with each other as well as with the efficacy of the axillary block (AX). At VIP1, we found a complete analgesia in 88% of the patients, whereas in 9% a supplementation was needed. ⋯ In general, the results of the VIP depended on the motoric answer to the nerve stimulation. There were no complications of the VIP such as nerve lesions or pneumothorax. The VIP using a nerve stimulator is a simple, reliable and uncomplicated method for plexus-brachialis-anaesthesia, which is easy to learn.