Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cognitive functions and cerebral oxygenation of older patients after general and regional anaesthesia].
The aim of the present study was to show the influence of cerebral oxygenation (regional cerebral oxygen saturation rSO(2) by near infrared spectroscopy) and of the nocturnal arterial oxygen saturation (SatO(2) by pulse oximetry) on the restitution of cognitive functions in patients aged between 40 and 85 years scheduled for elective hip arthroplasty. ⋯ Cognitive functions recovered completely during the first 3 postoperative days in patients scheduled for elective hip surgery under general or regional anaesthesia regardless of age and type of anaesthesia. This restitution of cognition occurred despite a significant decrease of cerebral oxygenation (rSO(2)) and despite an increase of nocturnal hypoxaemic intervals. Changes of the rsO(2) up to 3% below the baseline values (measured by NIRS) do not predict cognitive restitution. A minimal limiting value of the rSO(2) could not be defined.
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The vertical infraclavicular blockade of the brachial plexus (VIP) according to Kilka et al.is a technique which has gained more importance over the past years. This method distinguishes itself from other periclavicular techniques by a very low risk of pneumothorax (0.2%), which seems to be increased with asthenic patients. ⋯ As a consequence, we assume that if the distance between the leading points jugulum and ventral process of acromion is smaller than 20 cm, the puncture point for a vertical infraclavicular blockade of the brachial plexus should be lateralized as described above; additionally, the "finger-point" should be determined in order to verify the puncture point and to finally give an idea of the direction, in case of a possible need for correcting the puncture point.
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This review explains the different approaches to the brachial plexus (posterior cervical, interscalene, supra- and infraclavicular, and axillary) and their advantages and disadvantages (indications, contraindications, and complications) for surgery and postoperative or chronic pain management. One of the focussed areas of this review is the use of continuous catheter techniques. ⋯ As essential components for the success of those techniques, organizational and documentation requirements are described. In summary, regional techniques for single shot or continuous block of the brachial plexus are an efficient and safe way of providing anesthesia and analgesia for surgery or pain in the region of the shoulder, arm, or hand.
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For the repair of an open injury to the hand, a continuous axillary block was performed in a 40- year-old male patient. Slight resistance was experienced during advancement of the catheter. ⋯ Three days later the removal of the catheter proved to be difficult due to a knot in the distal part of the catheter. This seems to be the first report of a knot in a catheter used for continuous axillary plexus block.