Der Anaesthesist
-
Randomized Controlled Trial Comparative Study Clinical Trial
[Intrapleural bupivacaine and parenteral opioid for postoperative analgesia. A comparative study].
The intrapleural administration of local anesthetics via a catheter is a relatively new method for postoperative analgesia after thoracic and upper abdominal surgery. Many authors have described this technique as effective and with few side effects. METHODS. ⋯ The pO2 was significantly higher and the analgesia was significantly better than after intramuscular opioid administration. Moreover, the technique is simple to perform and has few side effects. We therefore believe it should be employed for postoperative analgesia after thoracic and upper abdominal surgery as well as for other indications to a greater extent.
-
Comparative Study
[The integration of thoracic epidural anesthesia into anesthesia for intra-abdominal surgery].
Upper abdominal and thoracic surgeries require efficient pain management. The complications of postoperative analgesia include respiratory depression and--when choosing the epidural route--possible damage to the spinal cord by infection, trauma, or bleeding. Therefore, thoracic epidural analgesia may appear to be too risky and is frequently cancelled although many studies have shown its excellent efficacy. ⋯ A primary perforation of the dura mater was noticed in 0.5% of cases retrospectively and 1.23% prospectively. Respiratory depression following epidural application of 0.3 mg buprenorphine was seen in 1 patient (0.05%). Continuous analgesia with local anaesthetics and/or opioids applied epidurally by a thoracic catheter was performed on the peripheral ward (n = 829, 40%) if close monitoring of the neurological status as well as rapid diagnosis of any painful paraesthesia or paraplegia was possible.
-
Anesthesia for craniotomies should guarantee hemodynamic stability, preservation of cerebral autoregulation, and rapid postoperative recovery of consciousness. Increases in intracranial pressure (ICP) and postoperative respiratory depression should be avoided. Combined anesthesia (KA) with N2O and volatile anesthetics may increase cerebral blood flow (CBF), ICP, and cerebral oxygen consumption. ⋯ CONCLUSION. Using the assumption that the diameter of the MCA is nearly constant, the reduction in BFV associated with an increase in pulsatility during TIVA is explainable as a decrease in CBF. By having a comparable influence on hemodynamics, the reduction in CBF with increase in cerebral vascular resistance seems to make TIVA the more advantageous anesthesia technique for patients with reduced intracranial compliance.
-
Randomized Controlled Trial Comparative Study Clinical Trial
[Droperidol versus metoclopramide. Prevention of emesis following strabismus surgery in children].
Vomiting after strabismus surgery is a major problem that remains as yet unsolved, especially in children. Droperidol and metoclopramide, both known as powerful antiemetic drugs, were compared in this study. METHODS. ⋯ Droperidol (0.075 mg/kg) and metoclopramide (0.15 mg/kg) both reduce postoperative vomiting after strabismus surgery. Droperidol seems to be more effective in reducing severe vomiting. Postoperative sedation after droperidol was not a major problem in our experience.
-
Case Reports
[A noncardiac pulmonary edema following aortocoronary bypass surgery. Diagnosis and therapy based on a case report].
Noncardiac pulmonary edema can occur not only after cardiac surgery with cardiopulmonary bypass but also after noncardiac operations. This so-called transfusion-related acute lung injury (TRALI) has been attributed to the transfusion of homologous blood and plasma. ⋯ This may be caused by leukocyte antibodies. Signs and diagnostic and therapeutic procedures are discussed with reference to a case report.