Der Anaesthesist
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Transoesophageal echocardiography (TEE) is recognised as a semi-invasive technique that has an increasing impact as a diagnostic tool in anaesthesia and intensive care medicine. However, adequate assessment of TEE is based on knowledge of basic echocardiographic principles and their limitations and sufficient educational training of the user. TEE has an established role in various clinical circumstances. ⋯ In patients with severe hypotension TEE may identify the cause, and thereby facilitate successful patient management. Moreover, TEE has an impact on the diagnosis of endocarditis and pathologic findings within the heart and pericardial sac. TEE-associated diagnosis and decision-making may lead to an improved clinical outcome, which in turn may lead to subsequent cost reduction.
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There is still a significant lack of treatment and rehabilitation facilities for chronic pain patients in Germany today. Most of all the treatment of low back pain and widespread pain syndromes or panalgesia is time consuming and complicated. The main problem of anaesthesiological pain clinics is the increase of these complex pain syndromes in the last years. ⋯ It is now clear that no one discipline or mode will suffice. Only a multidisciplinary and intensive approach will prevail, as discussed in this article. Unfortunately these multidisciplinary pain units are nearly not existing in Germany just as little as control of the effectiveness of pain treatment.
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Clinical Trial
[The interaction between rocuronium and smoking. The effect of smoking on neuromuscular transmission after rocuronium].
Recent studies have shown different results concerning the effects of smoking on neuromuscular blocking agents. Some reports indicate that smokers need higher doses of vecuronium, but are more sensitive to atracurium. The aim of this study was to evaluate the effects of smoking on onset and recovery time after a single 0.6 mg/kg intubating dose of rocuronium an analog of vecuronium. ⋯ The results of the present study suggest that chronic nicotine exposure does not change onset time or duration of rocuronium neuromuscular blockade. A previous study found a greater need for vecuronium in smokers and discussed stimulation of the neuromuscular junction and enhanced biotransformation due to the enzyme-inducing properties of nicotine. The differences in our results could be partly due to a longer period of refraining from smoking in our patients, leading to very low nicotine blood concentrations without the proposed receptor-stimulating effect. Another cause for different behaviour of the two analogs could be different elimination pathways. Recent investigations suggest that rocuronium may not be eliminated principally by the liver. Therefore, enhanced nicotine-induced biotransformation, as suggested for vecuronium, would not occur with rocuronium.
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The purpose of this study was to determine obstetrical pain management practices for labour for spontaneous and operative vaginal deliveries since there were no comparative German data available for the past 10 years. ⋯ The methods of obstetrical analgesia and anaesthesia are on a high level and show a broad homogeneity in all hospitals. Overall, the results indicate, in comparison to former studies and in common with other countries, steadily increasing use of regional anaesthesia performed by anaesthetists in contrast to decreasing numbers of local infiltrations performed by obstetricians.
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Mivacurium is a short-acting, nondepolarising muscle relaxant of the benzylisoquinoline type that undergoes rapid breakdown by plasma cholinesterase. After 2.5 times the ED95 (0.2 mg/kg), tracheal intubation can be accomplished within 2-3 min following injection. ⋯ The principal side effects of mivacurium are facial flushing and a transient fall in blood pressure due to moderate histamine release following doses 3-4 times the ED95. In patients with end-stage liver or renal disease as well as those with atypical plasma cholinesterase, the duration of action of mivacurium is prolonged.