Der Anaesthesist
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Imaging techniques with high spatial and temporal resolution (PET,fMRI, MEG) provide detailed information about the brains' processing of pain. Structures detected by these techniques are not understood as pain centers but as nodal points of a dynamic network which is influenced by physiological and psychological input. Imaging techniques can be used for the investigation of different pain components. ⋯ Until now only little is known about cortical structures mediating the cognitive pain component. In chronic pain the cortical and subcortical processing of nociceptive input is presumably modified. Reorganization in the primary somatosensory cortex is presented as an example of neuronal plasticity induced by chronic pain.
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Clinical Trial
[Quantification of blood loss. How precise is visual estimation and what does its accuracy depend on?].
Estimation of blood loss is a difficult task. Apart from measuring the volume of the suctioned blood the anaesthetist has to make a visual estimate of blood shed on the floor, spread in the surgeons' gowns and gloves and hidden in drapes and sponges at nearly every operation. We were interested in how exact visual estimation of blood loss can be and what factors influence accuracy and precision of the visual estimate. ⋯ Obviously our capability to estimate lost blood volumes is more influenced by our belonging to a professional group than by our professional experience. Do we not learn by experience? Diluted blood is overestimated, whereas in some other typical scenes blood loss is grossly underestimated. Simulations such as this one may improve our estimation capabilities and thus result in better patient care in the OR.
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Clinical Trial
[Danaparoid (Orgaran) as an antiocoagulant for mechanical autotransfusion with Cell Saver 5 (Hemonetics)].
We investigated Danaparoid Sodium (Orgaran) as anticoagulant using three different concentrations (9, 4,5 or 3 U/ml anticoagulant solution) for the use in the autotransfusion device Cell Saver 5 (Haemonetics). Fresh units of whole blood packs were mixed in the reservoir in a proportion of 5:1 with the anticoagulant solution. Having started the Cell Saver 5 in the automatic mode, the amount of Danaparoid in the retransfusion blood was determined (chromogenic Antifactor-Xa test). ⋯ One of them had slight clotting in the reservoir. We recommend the use of the lower concentrations tested: 4,5 U/ml or, particularly for patients with renal insufficiency or low body weight or expected high retransfusion volumes, 3 U/ml as anticoagulant concentrations. If the autotransfusion device is used according to the manufacturer's instructions there may be virtually no risk of clotting in the Cell Saver or of inhibition of the coagulation system in the patient.
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We report the case of a 4 year old boy who developed a massive water intoxication as a complication during knee arthroscopy. The sodium plasma concentration dropped to 100 mmol/l postoperatively. ⋯ The guidelines for replacing sodium in hyponatremia are discussed according to literature. In general, hyponatremia should be corrected in the same amount of time as it took for it to develop.