Der Anaesthesist
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Levobupivacaine, the S-enantiomer of racemic bupivacaine, will be available in Germany in mid-2004. Pharmacological studies demonstrated that, compared to bupivacaine, levobupivacaine has equal local anaesthetic potency with reduced potential for cardiac and CNS toxicity. This review introduces the new long-acting amide local anaesthetic levobupivacaine to the reader and evaluates its place in obstetric analgesia and anaesthesia compared to bupivacaine and ropivacaine.
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This is a report about an inadvertent intravenous infusion of 380 mg ropivacaine in a 84-year-old patient over a period of 1.75 h. The level of serum ropivacaine measured immediately after the end of the infusion as well as 2 h and 7 h later, was initially in the lower toxic range (free concentration of 0.48 micro g/ml). The patient showed no symptoms of intoxication neither clinically nor during the technical examinations (EEG, ECG). This case confirms the wide therapeutic range of ropivacaine.
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We report on a 23-year-old female patient who underwent removal of the implants after maxillary surgery. At the end of surgery the administration of anaesthetic agents was discontinued. During the following 30 min several attempts were made to wake the patient, but she did not respond to verbal or pain stimuli. ⋯ Retrospectively, the patient remembered the attempted wake-up period in detail. However, she reported no feelings of fear or helplessness because she had faith in the anaesthesiologist, a close friend of the patient's family for many years, who kept her calm and comfortable by talking to her during the entire period. Several months after the incident, the patient reported having neither increased fear of surgery nor any negative psychological effects on her life following this incident of awareness.
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Nociceptin is the endogenous ligand of a new opioid receptor, the opioid receptor-like-1 (ORL1) receptor. Chronic inflammatory pain causes an increase in the expression of nociceptin and the ORL1 receptor in the dorsal horn of rat spinal cord, thus indicating an involvement of the endogenous nociceptin/ORL1 system in mechanisms of pathological pain. This study investigates the influence of neuropathic pain on the expression of nociceptin using immunohistochemistry. ⋯ Although hyperalgesia was fully present after 5 days, no changes in nociceptin immunoreactivity in the lumbar spinal cord were detected at this time point. Ten days after nerve ligation, there was a 2.46+/-0.38 fold ( p<0.05) bilateral increase in nociceptin immunoreactivity in the lamina superficiales (I and II), with a notable increase in the inner lamina II at the level of L4. Further investigations are necessary to elucidate the relationship between neuropathic pain, the nociceptin-ORL1 receptor system and potential therapeutic options.