Der Anaesthesist
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Case Reports
[Brachial plexus. Long lasting neurological deficit following interscalene blockade of the brachial plexus].
An interscalene block of the brachial plexus was combined with general anaesthesia for repair of a complex chronic lesion of the shoulder. The localisation of the plexus with electro-stimulation and the injection of Bupivacain 0.5% were accomplished easily and without painful sensations. 48 hours later the block was still partially present. ⋯ The cause could have been due to direct traumatisation during blockade or operation, toxic action of the injected substance (Bupivacain 0.5%, 30 ml), distension of the plexus, a cervical syndrome or an aseptic plexitis, although a definite determination is not possible. However, the pattern of the lesion and the lack of pain during localisation of the plexus and injection favour traumatisation during the acromioplasty.
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Numerous factors have been claimed to influence postoperative nausea and vomiting (PONV). A critical review of the literature reveals, that strong evidence based on original double-blind, randomized, controlled trials or their meta-analyses is only available for very few risk factors. For most other factors, although mentioned in narrative reviews, there is insufficient evidence. ⋯ No evidence due to lack of data applies to postoperative movement, hemodynamic stability, hypercarbia and acid-base-shifts. For adipositas++ there is not only a lack of evidence for an effect but evidence for a lack of effect based on several multivariate analyses. In conclusion, we have developed the following simplified view: PONV is mainly caused by opioids and volatile anaesthetics when applied to susceptible patients (females, non-smoker, positive history of previous sickness).
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Historical Article
Introduction of the carbon dioxide absorption method with closed circle breathing into anesthesia practice.
The circle breathing CO2 absorption system for use during acetylene anesthesia was described by Carl Gauss in 1924/1925. The apparatus was manufactured by Drägerwerk of Lübeck. A considerable number of publications on the apparatus employing the closed circle method of CO2 absorption appeared in the medical press soon thereafter. ⋯ Information about all this was transmitted to America through the German medical press, including the Draeger-Hefte. American anesthesia machine manufacturers began to develop closed circle CO2 absorbers several years later. Claims that the circle breathing CO2 absorption method was introduced into anesthesia practice by Brian Sword are not valid.