Der Anaesthesist
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Up to now 136 cases of myocardial infarction during pregnancy have been reported, and angiography revealed normal findings in 47%. In these cases coronary spasms have been discussed as the major mechanism of the disease. In isolated cases coronary artery dissection may also present with a normal coronary angiography. ⋯ It was pointed out recently that even in asymptomatic patients, plaques may be present in coronary vessels indicating an early stage of CAD that cannot be diagnosed by angiography. Plaque rupture is often triggered by hypertension and may lead to myocardial infarction, instable angina pectoris, or sudden ischemic death. As IVUS is a new diagnostic tool that allows diagnoses of even early stages of CAD we believe that myocardial infarction during pregnancy is more often caused by plaque rupture than may be expected according to the current literature.
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Case Reports
[Transesophageal echocardiography as intraoperative monitoring for the resection of an intra-atrial tumor].
Fibrolamellar hepatocellular carcinomas (FLHCC) can grow into the inferior vena cava and the right atrium thus rendering it impossible to insert a pulmonary artery catheter or increasing the risk of tumor embolisation. We report of a young patient with intraatrial growth of a FLHCC where intraoperative transesophageal echocardiography (TEE) instead of a pulmonary artery catheter for continuous monitoring of hemodynamics was used. Hemodynamic parameters as well as the surgical result could easily be assessed.
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Fiberoptic intubation for the management of the difficult airway is usually achieved with the patient under light sedation. The goal of the present study was to evaluate the combination of propofol and remifentanil for sedation during fiberoptic intubation. ⋯ Our combination of remifentanil and propofol was shown to be a safe sedation regimen for fiberoptic intubation. Monitoring ventilation via nasal capnography and arterial oxygen saturation via pulse oximetry provided sufficient patient safety.
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Inapparent adverse intraoperative wakefulness is still a relevant problem in modern anaesthetic routine. It can be associated with serious negative effects on the postoperative recovery of the patients. Several different procedures have been developed to monitor and therefore avoid intraoperative situations of wakefulness during general anaesthesia. ⋯ There is a hierarchical correlation between certain values of the MLAEP and intraoperative wakefulness defined by purposeful movements, amnesic awareness with only implicit recall and conscious awareness with explicit recall. For some of the most commonly used anaesthetics reasonable threshold values of the MLAEP for the different states of consciousness have already been determined. Future studies in broad patient populations with all of the different routinely used anesthetics and procedures will have to finally identify the importance of the recording of mid-latency auditory evoked potentials as a routine method to assess the depth of anaesthesia.