Der Anaesthesist
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In this article current indications and limitations of neuromuscular monitoring are reviewed. Attention is mainly focused on detection of residual curarisation. ⋯ Surprisingly in this context, despite the benefit of neuromuscular monitoring, its utilisation in clinical practice is rather an exception than the routine. A lack of standardisation of neuromuscular monitoring is probably the major problem on the way to a widespread utilisation of the monitoring.
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The choice of cisatracurium, especially for patients with organ dysfunction, seems to be beneficial, because of organ-independent Hofmann-elimination and less histamine release propensity. This study was designed to investigate pharmacodynamics and intubating conditions after bolus administration of 0.15 mg/kg cisatracurium (3 x ED95) in patients with renal failure and maintained with isoflurane/N2O in oxygen. ⋯ The result of this clinical study suggest, that cisatracurium is a suitable choice for patients with renal failure. The necessity for an intraoperative neuromuscular monitoring is given by the marked heterogeneity in the recovery parameters in patients with renal failure.
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Case Reports
[Cesarean section with continuous spinal anesthesia in a cardiopulmonary high-risk patient].
As a consequence of the progress in (perinatal) medicine the number of pregnant women with severe cardiopulmonal risk, who need caesarean delivery, is rising. The anaesthetic care of these patients requires optimal preparation and--as a prerequisite--constant intraoperative vital functions (heart rate, blood pressure, oxygen saturation). Typical risks like airway-problems, hypoxia, hyper- and hypotension and tachycardia must be strictly avoided. We report a case of successful caesarean delivery in a patient with severe coronary heart disease, using spinal catheter technique. ⋯ This case demonstrates, that the use of a continuous spinal catheter technique for caesarean section anaesthesia is an alternative method, which should be considered especially in high risk patients, when meticulous care for constant vital functions is requested urgently.
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Randomized Controlled Trial Clinical Trial
[The effect of gamma-hydroxybutyrate (GHB) on proinflammatory cytokine gene expression in coronary surgical procedures].
To determine the influence of gamma-hydroxy-butyrate (GHB) on spontaneous and lipopolysaccharide (LPS)-stimulated release of tumour necrosis factor-alpha (TNF), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and interleukin-10 (IL-10) in whole blood from patients undergoing coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC). In addition, the pharmacological modulation on lipopolysaccharide (LPS)-stimulated cytokine release by GHB (GHB-Na and GHB-ethanolamide) was characterized in a separate in vitro-assay. ⋯ The results suggest a biphasic response of stimulated PBMC cytokine gene expression during CABG with an initial tolerance to LPS-stimulation shortly after termination of ECC. However, whether or not PBMC express functional GHB receptors remains unclear in light of contradictory effects of the different ligands. In spite of the ex vivo and in vitro results, application of GHB-Na in doses which are primarily based on its use as an anesthetic agent do not seem to modulate the release of the cytokines studied.
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Innate and acquired immunity plays a pivotal role in the host defense response. Pain, stress, necrotic tissue and invading microorganisms are known modulators of the complex immune response of patients undergoing major surgery. Anaesthesia itself or perioperative interventions of the anaesthesiologist may substantially alter the immune function with potential impact on the postoperative course. ⋯ However, these actions may only be apparent with high or supraclinical concentrations and/or long-term exposure. Regarding the latter, evidence suggests that long-term sedation using thiopentone in neurosurgical patients is paralleled by infectious complications in a dose-dependent manner. At present, no data are available regarding the significance of the observed alterations associated with various anaesthetic procedures of the incidence of postoperative complications associated with impaired immunity, such as infection or metastatic spreading in oncological surgery.