Der Anaesthesist
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Case Reports
[Inadvertant suture fixation of a Swan-Ganz catheter to the pulmonary artery following heart surgery].
We report a patient undergoing redo cardiac surgery for combined replacement of the aortic and mitral valves. During the course of the operation, a Swan-Ganz catheter - positioned preoperatively - was accidentally fixed to the wall of the pulmonary artery. As this did not interfere with cardiac output measurement or the pulmonary artery pressure wave form, the fixation was not noticed until an attempt was made to remove the catheter. ⋯ The patient required a sternotomy to remove the catheter. In order to avoid this complication, the indications for pulmonary artery catheters during cardiac surgery should be carefully considered. If catheters are inserted, their mobility should by all means be ensured before the chest is closed.
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Various in vitro models have been introduced for comparative examinations of post-dural-puncture trauma and measurement of liquor leakage through puncture sites. These models allow simulation of subarachnoid, but not of peridural, pressure. A new two-chamber-model realizes the simulation of both subarachnoid and peridural pressure and allows observation of in vitro punctures with video-documentation. Frame grabbing and (computer-aided) image analysis show new aspects of spinal puncture effects. Therefore, post-dural-puncture trauma and retraction can be objectively visualized by this method, which has not previously been demonstrated. ⋯ The two-chamber-model presented allows easy simulation of physiological subarachnoid and peridural pressure. The Ringer lactate solution in the subarachnoid chamber corresponds to the liquor, whereas that in the peridural chamber corresponds to the intercellular (peridural) space. The tension of the dural patch between the polyamide seals is similar to the situation in an anotomical model observed by spinaloscopy (in an earlier study). With the video documentation and computer-aided analysis technique introduced, dural trauma and retraction of the puncture site can be examined and demo
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The needle type introduced by Edward Tuphy for continuous spinal anaesthesia in 1944 is still used as the standard instrument for epidural anaesthesia up to the present day. Puncture of the dura and severance of the epidural catheter are the typical, though fare, complications of this procedure, giving rise to most of the actions brought for damage suffered during obstetric anaesthesia. The cerebral spinal fluid loss caused by thick needles can have serious consequences, including subdural and intracranial haematoma, cranial nerve pareses, labyrinthine hearing impairments and pneumocephalus. ⋯ For continuous spinal anaesthesia this needle has been available without the modified opening geometry since 1989 in sizes 22 G and 24 G and is wide by used in Europe. CSE technique with special and standard Sprotte needles. Spinal analgesia or anaesthesia) can be performed with the special needle and 123-mm-long 27 G or 29 G standard Sprotte needles before placement of the peridural catheter.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Qualitative comparison of modified neurolept-, balanced and intravenous anesthesia. 2. Results of a clinical study, 1992].
The safety and tolerance of neuroleptanaesthesia (NLA), balanced anaesthesia (BAL), and intravenous anaesthesia with propofol (IVA) were analysed for the first time in a prospective, randomised clinical trial. METHODS. In all, 1318 surgical patients received either NLA, BAL, or IVA. ⋯ CONCLUSION. The present results show clear clinical advantages of BAL and IVA in contrast to neuroleptanaesthesia. Due to the very low incidence of side effects such as nausea and vomiting IVA was highly recommended by the patients, at least in part because of the rapid recovery time.
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Randomized Controlled Trial Clinical Trial
[Does controlled hypotension with nitroprusside affect platelet function?].
Induced hypotension is an accepted technique to reduce intraoperative blood loss and thereby ensures satisfactory operating conditions, especially in microscopic interventions. Sodium nitroprusside (NP), which is often used for induced hypotension, was reported to inhibit platelet aggregation in vitro. Impairment of platelet function implies a higher bleeding risk, which would make the use of NP for induced hypotension questionable. ⋯ In contradiction to in vitro studies using high concentrations of NP, we could not find a decrease in platelet aggregation due to hypotensive anaesthesia with this drug in vivo. In the control group a significant increase in platelet aggregation was observed, which was probably counteracted in the hypotensive patients by the interaction of NP with cyclic guanosine monophosphate (c-GMP). NP augments the intracellular concentration of c-GMP, which is known to decrease platelet aggregation.