Der Anaesthesist
-
Multiple organ failure remains the major cause of death in critically ill patients. In view of therapeutic strategies, current research activities focus on the cellular response to different kinds of cellular stress (hypoxia, oxidative damage and mechanical distress) in the pathogenic sequelae of organ failure. The cellular stress reactions are characterized by induction of adaptive programs of gene expression (e.g. acute phase proteins, heat shock proteins, hypoxia-associated proteins) to protect the cells from energy depletion and cell death. ⋯ Depending on the acuity of the stressor, the cell dies due to necrosis or apoptosis. Dysregulation of the balance of apoptosis and necrosis in different organs seems to be an important mechanism in the development of organ failure. New insights into the cellular mechanisms during organ dysfunction promote the development of new diagnostic (e.g., optical and spectroscopic) and pharmacological tools leading to a better prevention and therapy of organ failure.
-
A 53-year-old woman diagnosed as having hereditary motor-sensory neuropathy Charcot-Marie-Tooth (CMT) disease Type 2, underwent inguinal hernia surgery. In this patient CMT disease was manifested as distal muscle weakness and wasting. Anaesthetic experience with patients who have CMT disease is limited. ⋯ We describe a total intravenous anaesthesia (TIVA) protocol with propofol and alfentanil without any muscle relaxants after fiberoptic intubation. The patient made an uneventful recovery and was discharged from the hospital on the fourth postoperative day. TIVA was a safe technique in this patient and should be considered as an alternative for patients presenting with CMT disease.
-
We report on a case of fatal perforation of the superior vena cava. The perforation occurred after catheterization of the left internal jugular vein with a hemodialysis catheter, due to an unrecognised stenosis of the superior vena cava. Vascular trauma induced by a previous, also left-sided, subclavian vein-hemodialysis catheter (in place for 14 days), seemed to be the most likely pathomechanism of the stenotic lesion. ⋯ After placement of hemodialysis catheters, in particular left-sided catheters, we demand chest X-ray in order to verify that the catheter runs parallel with the long axis of the superior vena cava. In doubtful cases the threshold for contrast-enhanced angiographic control of the catheter should be low. If a perforation by the catheter is suspected it should be ruled out by computed tomographic scanning or transesophageal echocardiography.
-
Air embolisms frequently occur during neurosurgical operations. For detection of air embolisms, a re-usable doppler probe, integrated in a central venous line, is described. In an in-vitro test series the measuring sector as well as the function of a 8 MHz doppler probe are presented. ⋯ A reliable detection of micro-bubbles in this test model is possible by means of a 8 Mhz doppler probe. Further animal and clinical studies are planned.