Der Anaesthesist
-
Pulse contour cardiac output (PCCO) is an easily applicable method for continuous measurement of cardiac output in critically ill patients. Calculation of stroke volume is possible by analysing the area under the systolic part of the arterial pulse pressure waveform together with an individual calibration factor (Zao) to account for the individually variable vascular impedance. Since vascular impedance is potentially affected by altered vascular tone, it was the aim of the present study to examine the validity of PCCO in ICU patients receiving various dosages of a variety of vasoactive drugs. ⋯ Alteration of vascular tone by clinically used dosage of vasoactive drugs, however, had no destabilizing effect on the pulse contour method. CONCLUSIONS. It could be demonstrated that PCCO provides a valuable method for continuous cardiac output measurement in the intensive care setting with a precision comparable to that of thermodilution.
-
We have studied mid-latency auditory evoked potentials (MLAEP) during general anaesthesia with sufentanil in ten patients scheduled for elective major urological surgery. Anaesthesia was induced with sufentanil 2-3 micrograms/kg; for maintenance of anaesthesia a further bolus of sufentanil (1-2 micrograms/kg) 10 min before the start of surgery (skin incision) was given. MLAEP were recorded before and 10 min after the last sufentanil bolus on the vertex (positive) and mastoids on both sides (negative). Latencies of the peaks V, Na, Pa, Nb, and Pl (ms) and amplitudes Na/Pa, Pa/Nb, and Nb/Pl (microV) were measured. ⋯ There is no substantial difference of sufentanil's effect on MLAEP compared with the opioids alfentanil, fentanyl, and morphine. Because Na, Pa, and Nb are generated in the primary auditory cortex of the temporal lobe, it must be concluded that during general anaesthesia with sufentanil primary cortical processing of auditory stimuli may be preserved.
-
Friedreich's disease is a very rare neurological disorder that causes degeneration of the posterior roots of the spinal nerves and progresses to the anterior roots, even in young adults. Hospital emergency teams face the question of choice of anaesthesia in such patients should general anaesthesia be preferred to regional anaesthesia. We report a 36-year-old patient with spinocerebellar heredoataxia (Friedreich's disease) who underwent a proctological procedure after administration of spinal anaesthesia with 3 mg hyperbaric bupivacaine in a sitting position. Both the intra- and post-operative courses were unremarkable; in particular, with regard to the underlying neurological disease, no complications were observed.