Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Acoustic evoked potentials of medium latency. Anesthesia induction with S-(+)-ketamine versus ketamine racemate].
Mid-latency auditory evoked potentials (MLAEP) reflect the primary cortical processing of auditory stimuli. They are widely suppressed during general anaesthesia with volatile anaesthetics. Under ketamine, in contrast, they seem to be preserved, which has been interpreted as indicating insufficient suppression of consciousness during ketamine anaesthesia. ⋯ MLAEP do not change in amplitude or latency during induction of general anesthesia with S-(+)-ketamine or ketamine-racemat. Primary cortical processing of auditory stimuli seems to preserved under S-(+)-ketamine and ketamine-racemat. This must be viewed in connection with dreams and hallucinations and could be interpreted as inadequate suppression of auditory information processing during general anaesthesia with S-(+)-ketamine and ketamine-racemat.
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Treatment of postoperative pain is often insufficient. It normally consists of systemic application of an analgesic drug or a regional technique of analgesia. Fentanyl-TTS may be a new approach for postoperative pain therapy. ⋯ Local reactions under the patch were erythema (39%) or pruritus (9%). These phenomena disappeared within a few hours. The pharmacokinetics of fentanyl-TTS have two major drawbacks: during the first 12-15 h the patients need supplementary analgesics, usually opioids.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Respiratory gas exchange. Anesthesia with enflurane or isoflurane in nitrous oxide during spontaneous and controlled ventilation].
The estimation of oxygen consumption and carbon dioxide elimination is essential for predicting the metabolic activity and needs of any patient having anaesthesia. During anaesthesia oxygen consumption can be measured and compared to a predicted value. However, oxygen uptake is affected by anaesthetic agents, which complicates the interpretation of measured oxygen uptake rate. ⋯ The mean oxygen uptake rate at 10 min was between 2.0 and 2.2 ml.kg-1 x min-1 in all groups. At 30 min the mean oxygen uptake rates were 2.6 to 2.8 ml.kg-1 x min-1. Carbon dioxide elimination was closely associated with expired minute ventilation, with a carbon dioxide excretion of about 30 ml per litre gas exhaled, irrespective of ventilatory mode employed.
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Case Reports
[Fiberoptic intubation in the prone position. Anesthesia in a thoraco-abdominal knife stab wound].
An ambulance was dispatched to a 40-year-old man with a stab wound. On arrival, the emergency physician found the patient lying face down with a large knife protruding from his back between the scapula and spinal column (Fig. 1). The vital signs were stable (blood pressure 120/70 mmHg, heart rate 90 min, respiratory rate 25-30 min, oxygen saturation 94%); the estimated blood loss was 500 ml. ⋯ During positioning of the patient in the operating theatre, the knife was unintentionally dislodged and critical bleeding occurred. The situation could be controlled by immediate transfusions and rapid surgical revision, which revealed injuries to the lung, diaphragm, and stomach. The patient recovered without severe complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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Laparoscopic cholecystectomy is claimed to be a minimally invasive procedure, but uptake of carbon dioxide (CO2) from the pneumoperitoneum (CO2-PP) can cause clinically relevant hypercapnia. In this prospective study, CO2 resorption during laparoscopic cholecystectomy was investigated. METHODS. ⋯ During dissection of the gallbladder no increase in CO2 resorption was observed, so the experimental finding [19] can be confirmed clinically that an IAP higher than the venous capillary pressure protects from further CO2 resorption by compressing the venous capillaries of the peritoneum. CO2 resorption is clinically relevant because VI must be increased to maintain normocapnia. Therefore, capnography is absolutely necessary during laparoscopic cholecystectomy.