Der Anaesthesist
-
Clinical Trial
[Patient-controlled postoperative epidural analgesia. Prospective study of 1799 patients].
Side effects of postoperative epidural analgesia can be controlled by two strategies: Insertion of catheters into the center of the affected spinal segments and coadministration of local anesthetics and opioids. Both techniques will reduce single drug dosage. Additionally synergistic effects will result in excellent analgesia and the risk of side effects and complications will be minimized. ⋯ Mean VAS-scores during the postoperative observation-period were within the prior defined limits. On the morning after surgery, however, a reduction in pain relief was observed and analgesia on the first postoperative day could significantly be improved after a 24-h on call pain service has been introduced. Except urinary retention side effects are rare. Probability of motor-blockade is significantly lower in patients with thoracic compared to patients with lumbar catheters. Not any patient suffered from severe complications such as sedation or respiratory depression.de
-
Pheochromocytomas are functionally active, catecholamine-secreting tumours of chromaffin tissue. The mainstay of pharmacological therapy is preoperative treatment with oral phenoxybenzamine. This drug irreversibly alkylates alpha-1-adrenergic receptors on vascular smooth muscle and renders them nonfunctional, thereby causing vasodilatation. ⋯ After complete resection of a total of three tumours, no further hypertensive crises occurred. The patient's postoperative course was uneventful. We conclude that in this patient presenting with an unsuspected multilocular pheochromocytoma, the lack of permanent alpha-blockade was probably helpful in allowing complete resection of all the tumours.
-
Postoperative pain therapy, i.e., the symptomatic treatment of acute post-surgical pain, is an interdisciplinary obligation of the anaesthesiologist and managing surgeon toward the patient. The failure to provide appropriate pain therapy, in particular withholding analgesic agents, can be regarded as malpractice and result in civil, criminal, and professional legal consequences. As with other medical treatments, the patient must be adequately informed about pertinent details prior to the use of pain therapy, particularly in regard to specific risks and feasible alternative measures. All pain therapy employed must be duly recorded.
-
Unnoticed, minor damage to the unidirectional respiratory valves of the Draeger respiratory circuit may lead to intermittent and unpredictable malfunction, resulting in rebreathing and hypercapnia. The damage may be so minor that normal visual and functional test routines may be insufficient to detect it. We report one case of a potential life-threatening malfunction of the inspiratory valve and also propose economical solutions utilizing altered construction, modified machine-check procedures, or a simple instrument that adds only one step to the machine-check procedure. ⋯ This problem results in a significant but incalculable increased in risk to patients. Because of unclear reproduceability of intermittent malfunctions caused by borderline damage, there also is an increased forensic risk for the anaesthesiologist. The risk of mechanical malfunction might be displaced by software problems in new-generation ventilators in the market.