Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Neuromuscular blockade after atracurium and alcuronium with propofol and thiopental].
Does propofol or thiopentone enhance the effect of nondepolarizing muscle relaxants? We evaluated the effects of propofol and thiopentone on the pharmacodynamics of atracurium and alcuronium in 43 surgical patients (ASA I and II) under general anaesthesia. ⋯ Propofol and thiopentone have no potentiating influence on the time course of action and the magnitude of relaxation with alcuronium and atracurium. Pharmacodynamics of nondepolarizing muscle relaxants do not seem to be influenced by these two hypnotics.
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Comparative Study
[Acute spinal subdural hematoma after attempted spinal anesthesia].
This is a report of a case of a subdural haematoma with resulting paraplegia after attempted spinal anaesthesia. Epidural and subdural haematomas are rare complications after central neural blockade. The complication described here was the result of an unsuccessful attempt to puncture the spinal channel. ⋯ A similar case was published in 1988 by Parker. In the present case it must be assumed that the vessel was punctured during a paramedian approach in the area of the foramen intervertebrale, as the spinal channel was definitely not entered. Although this is an extremely rare complication, we conclude that close neurological controls are essential at least during the first 24 h after surgery, even after an unsuccessful attempt at central neural blockade.
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Portofemoro-axillary bypass systems are commonly used to treat adverse haemodynamic effects during the anhepatic phase of orthotopic liver transplantation (OLT). However, low shunt flows may reduce the efficacy of these bypass systems. In order to improve veno-venous bypass management, a percutaneous cannulation technique (PCT) was used to insert large-bore catheters (21 F) into the left femoral and subclavian veins. This study prospectively addresses the complications of the PCT in 195 adult patients undergoing 203 OLTs. ⋯ The portofemoro-subclavian bypass can be performed by percutaneous cannulation without additional complications in patients undergoing OLT. Although haemorrhagic complications following central venous catheterisation are reported to occur in patients with haemostatic defects, none of them was observed in this study. Two events of air embolism and one cardiac arrest could not be related to the PCT. In conclusion, femoro-subclavian percutaneous cannulation is a simple, rapid, and safe alternative to commonly used veno-venous bypass systems.
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The standard procedure when difficulties are anticipated with intubation, e.g. following the clinical classification as per Mallampati, is the fibreoptic bronchoscopic method applied while the patient is awake. In the case of unexpected difficulties encountered during intubation while the patient is anaesthetized, a scenario that cannot be absolutely ruled out, e.g. in an emergency resection when there is no longer a simple method of returning the patient to the waking condition, and when problems are accentuated by seriously hampered mask respiration, aspiration risk, danger of hypoxia, and visual obstruction by secretions and blood, the fibrebronchoscope is no longer the instrument of choice. A larynx mask or a combination tube is probably a better option. ⋯ The BL is routinely deployed, as an alternative to the Macintosh instrument, for practice purposes by all our colleagues in the department. It has proved to be remarkably effective: to date it has led to the target quickly and without complications in every case. As examples three case histories selected from a series of cases in which the BL was used have been highlighted.
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Historical Article
[Artificial respiration with technical aids already 5000 years ago?].
Performed at the end of the mummification process, the "mouth-opening" ritual was a ceremony for the spiritual resurrection of the dead Pharaoh. The techniques used are astonishingly similar to modern emergency-room procedures. For example, the mouth-opening device was made of meteoric iron. ⋯ There are other signs of medically sound methods in the mouth-opening ritual. Symbolically, the mummy's teeth were extracted, the eyes opened with a special device, and gold capsules inserted, perhaps in the sense of a breathing tube. There is a possibility that this ritual contains a forgotten synopsis of knowledge gained empirically in connection with the Egyptian cult of royal resurrection.