Der Anaesthesist
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Clinical Trial
[Ultrasonography and peridural anesthesia. Technical possibilities and limitations of ultrasonic examination of the epidural space].
Epidural anaesthesia (EA) is the most important analgesia technique in obstetrics for delivery. In pregnancy, hormonal adjustments lead to an alteration of tissue consistency, which often causes an early, untimely loss of resistance. Apart from mere inspection and palpation, no useful diagnostic method prior to EA performance has been established yet. ⋯ Ultrasonography offers the possibility to determine site and direction of epidural puncture and distance of the epidural space to the skin even before the puncture attempt. The ultrasound controlled EA for delivery can easily be inserted into the clinical routine. Ultrasonography can fill an important diagnostic gap in regional anaesthesia.
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Case Reports
[Intraoperative diagnosis of pheochromocytoma preoperative symptoms in a case of Recklinghausen's disease].
Phaechromocytoma is a rare catecholamine secreting tumor, which occasionally presents as a life threatening crisis in association with surgery and anesthesia. We report a 58-year-old women with known Recklinghausen's disease who was admitted for elective resection of a pancreas tail cystadenoma. A cystadenocarcinoma was taken into account differential diagnostically. ⋯ Phaeochromocytomas are observed in patients suffering from Recklinghausen's disease (and other phacomatoses) in an above average incidence. Therefore, such a tumor should be excluded in these patients before elective surgery even if the patient does not show symptoms (asymptomatic phaeochromocytomas occur). The determination of catecholamines in 24 hour urine collections is an easy and specific diagnostic procedure and should be used in patients suffering from phacomatoses before elective surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Cisatracurium in coronary bypass operations--a comparison with pancuronium. Hemodynamic and neuromuscular effects in patients under chronic beta blocker treatment].
The aim of the study was to compare haemodynamic and neuromuscular effects of cisatracurium and pancuronium in patients undergoing coronary artery bypass grafting (ASA III, good or moderately impaired LV function) who were chronically medicated with beta-adrenergic blocking agents. ⋯ Under high-dose opioid induction, bradycardia must be considered if cisatracurium is administered to cardiac surgery patients.
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In this study we compared operating room (OR) efficiency of total intravenous anaesthesia (TIVA) with remifentanil and propofol and balanced anaesthesia (BAL) with fentanyl and isoflurane in cataract surgery using computersimulation. We simulated patient flow for one OR and for three ORs. Time intervals of patient flow were randomly generated from the results of a prospective, randomized trial. ⋯ Overtime in the PACU was less after TIVA. With a workload of 13 or 15 operations per day in three ORs, monitoring equipment for an additional patient in the PACU was required when BAL was used. TIVA with remifentanil and propofol was associated with more OR efficiency than balanced anaesthesia with fentanyl and isoflurane when given for cataract surgery.