Der Anaesthesist
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Clinical Trial
[Electric nerve stimulation in relation to impulse strength. A quantitative study of the distance of the electrode point to the nerve].
In the present study the difference of the distances of the tip of the needle to the nerve at similar current intensities but different pulse widths (100 microseconds vs. 1000 microseconds) were determined by means of 20 blockades of the sciatic nerve using the transgluteal approach of Labat. Comparable current intensities at different pulse widths (100 microseconds vs. 1000 microseconds) were compared in the same way, using the same position of the needle. At a pulse width of 100 microseconds and a current intensity of 0.30 mA, the tip of the needle is on an average of 5.0 mm closer to the nerve than with a pulse width of 1000 microseconds and a comparable current intensity of 0.28 mA (difference statistically highly significant; p < 0.005). ⋯ The success rate of the blockade was 95% at a current of 0.30 mA at 100 microseconds. Nerve lesions or other complications have not been seen. In conclusion, safe and successful nerve blocks in patients without polyneuropathia using the peripheral nerve stimulation seems to be obtained at a current intensity of about 0.30 mA at a pulse width of 100 microseconds.
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Tracheobroncheal rupture is a rare complication of intubation techniques using a stylet. In this case report the patient was intubated by an emergency physician in a preclinical setting after a motor vehicle accident. Iatrogenic tracheal laceration was masked by inappropriate position of the endobronchial tube. ⋯ In this case two complications of endobronchial intubation occurred, but the deep tube placement opposed the effects of the tracheal laceration. This was probably life saving for the patient during emergency transfer by helicopter after the accident. The anaesthesiological management during tracheal repair is discussed.
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Laparoscopic surgery of the gallbladder has increasingly replaced open techniques due to postoperative benefits (less pulmonary complications, less postoperative pain, earlier mobilisation). Specific intraoperative effects of pneumoperitoneum have led to some uncertainty if cardiac and/or pulmonary high-risk cases should be done laparoscopically. We describe anaesthesiological management of a 72 year old patient with a unilateral leftsided honeycomb lung (two very large cysts) to undergo laparoscopic cholecystectomy. ⋯ The patient could be discharged from hospital on day seven and fully recovered. Especially the severely cardiopulmonary compromised patient benefits from a laparoscopic procedure, due to less postoperative reduction of pulmonary function. Careful and individually adapted monitoring and anaesthetic techniques are necessary to successfully counteract the special implications of pnemoperitoneum.