Der Anaesthesist
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In the postoperative period patients are at risk of excessive oxygen consumption (VO2). However, patients suffering from cardiovascular disease may be unable to increase their oxygen transport capacity sufficiently and may be especially vulnerable to tissue hypoxia as part of the reaction to intraoperative stress. During the last 10 years conflicting results concerning the benefits of a combined epidural and light general anaesthesia have been published. ⋯ In the early postoperative period (5 min) patients in group 1 showed a VO2 or 3.6 +/- 0.4 ml.kg-1.min-1. This was the same as in group 3 (3.5 +/- 0.3 ml.kg-1.min-1). In contrast, in group 2 a VO2 of 5.3 +/- 0.7 ml.kg-1.min-1
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In the last few years epidural analgesia with bupivacaine and/or opioids has become an important technique in the therapy of postoperative pain. Using bupivacaine only 2-20% of the patients are treated without sufficient success. To ascertain and evaluate the underlying reasons for this, we prospectively investigated 51 patients routinely, and 6 patients with an insufficient analgetic effect from a group of 212 patients, by means of epidurography. ⋯ The epidural position of the catheter--central or lateral in the epidural space--seems, however, not to be particularly important. If high-quality analgesia is to be achieved with bupivacaine alone, or in combination with an opioid, the catheter should usually be placed near to, or better into the centre of the segments to be treated. The results demonstrate that in the case of failure of epidural catheter therapy, epidurographic examinations are very helpful in ascertaining and evaluating the underlying reasons for this failure and in coming to a logical decision for changing the concept.
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Basic monitoring in cardiac anaesthesia embraces at least 19 different parameters of haemodynamics and blood gas analysis. In special cases additional measurements may be desirable, providing a total of up to 44 variables displayed on various monitors, as depicted in Fig. 2. The recording of such an amount of data is only feasible with automated recording systems. ⋯ Automated monitor data record systems are considered to be a prerequisite not only for research in anaesthesia but also for quality assurance. A basic requirement for wide acceptance in clinical practice is a user interface that provides fast and convenient key inputs as well as further information about parameters not displayed on other monitors. In our h
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Epidural analgesia is a very efficient method of postoperative pain management. Nevertheless, problems such as unilateral analgesia, sensory loss and inadequate pain relief are often difficult to handle. Radiologic evaluation of the position of the catheter and the spread of radiopaque dye (epidurography) is an important advance toward a solution of these problems. ⋯ In our view epidurography is a valuable way of improving the quality and safety of postoperative epidural analgesia. It is an important tool for decision-making in the event of clinical problems. The benefits for the patients have to be weighed against the radiation exposure.
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Spinal cord stimulation (SCS) has routinely been used since the beginning of the 1970s. The initial indications for stimulation were the so-called deafferentation or neurogenic pain. Further work has confirmed that neurostimulation is useful in severe peripheral vascular disease in relieving pain and increasing capillary blood flow and oxygen tension. ⋯ During SCS treatment significant improvement was obvious: chest pain, ST-segment depression, and the extent of heart failure could be reduced. Both patients reached a better NYHA functional class, exhibited increased working capacity and reported reductions in anginal attacks and pain. Th