Der Anaesthesist
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Comparative Study
[Combined anesthesia with epidural catheter. A retrospective analysis of the perioperative course in patients ungoing radical prostatectomy] .
Patients requiring radical prostatectomy (rPE), including retroperitoneal lymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in terms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hospital were retrospectively reviewed. ⋯ Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO2 and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.
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Mechanical ventilation is the mainstay of therapy for acute lung injury, a disease with remainingly high morbidity and mortality. As a result of an improved understanding that mechanical ventilation itself can contribute to and aggravate the disease process, the term ventilator-associated lung injury (VALI) has been introduced. Main risk factor for VALI are (1) alveolar overdistention caused by excessivly high tidal volumes and/or inspiratory pressures (volu-/barotrauma), as well as (2) cyclic alveolar collapse promoted by insufficient endexpiratory pressure. ⋯ An initial lung volume recruitment manoeuvre is mandatory for the optimal use of HFOV. Whereas for many years HFOV is a well established therapy for the infant respiratory distress syndrome, experience in adults is still rare. First results, however, look promising, and HFOV might as well turn out as a valuable treatment modalitiy for ARDS.
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This case report describes an epidural abscess with pseudomonas aeruginosa after the placement of two epidural catheters within one hour in a healthy 29-year old primipara. Spontaneous delivery occurred after an episiotomy about 4 hours later. Afterwards the epidural catheter was removed completely and again 5 hours later the woman was discharged from the hospital. ⋯ In this case report a hematogenic infection was considered. The traumatized tissue from the two catheter placements within one hour could easily be colonized with pseudomonas aeruginosa originating from a transient bacteriemia due to an episiotomy inspite of adequate local disinfection measures. The case report also underlines the need for proper information of the patient about the possibilities of complications after epidural anesthesia in outside patients.
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Ischemia-induced changes of diastolic leftventricular (LV) properties commonly precede corresponding ECG-changes. In the present experimental study the consequences of acute normovolemic hemodilution (ANH) induced dilutional anemia (hematocrit, hct 20%) for LV diastolic function were investigated. A total of 22 anaesthetized, splenectomized beagle dogs breathing room air were hemodiluted with isooncotic hydroxyethylstarch solution (6% HAES 200,000/0.5) until a hct value of 20% was reached. ⋯ Signs of subendocardial perfusion mismatch were not encountered. Presumed that the coronary vascular system is intact ANH to hct 20% does not provoque changes of LV diastolic function. Moreover neither myocardial perfusion and oxygenation nor myocardial function are endangered by this degree of dilutional anemia.