Der Anaesthesist
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Neuralgic pain during or following herpes zoster infection is a common problem in pain therapy. The current management of neuralgias due to zoster is discussed with reference to patients in a chronic pain clinic within an anesthesiology department. The courses of 80 patients followed up for at least 3 months from the pain clinic at the University Hospital in Kiel were analyzed. ⋯ If the history of zoster pain was less than 1 month, the majority of patients showed good or excellent results. On the other hand, only one-third of patients with a history longer than 6 months had adequate pain relief. Therefore, early and appropriate treatment is desirable for patients suffering from zoster neuralgias.
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In 87 patients a new computerized EEG monitor was used in clinical anesthesia. Following aperiodic analysis, the Lifescan shows the computerized EEG in a striking color visualization allowing recognition of changes in the course of the EEG and of interhemispheric differences. The computerized EEG can be read after a brief training period. ⋯ The effect of combined anesthesia, however, was difficult to judge. In carotid artery surgery a quick unilateral decrease in activity and slowing of frequency indicated cerebral ischemia and quickly disappeared after insertion of a shunt. This change was particularly obvious with the new monitor.(ABSTRACT TRUNCATED AT 250 WORDS)
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This report describes a cardiac arrest that occurred in a 4-month-old infant during induction of anesthesia. During the administration of N2O/O2 and halothane via a face mask tachycardia was noted and rigor followed the application of succinylcholine for intubation. Shortly thereafter cardiac arrest occurred; 15 min later we found a profound metabolic acidosis as well as signs of rhabdomyolysis with a serum potassium level of 10.3 mmol/l and an increase in serum creatine kinase (CK). ⋯ To what extent a MH episode may have contributed to the clinical picture cannot be determined at present. The spectrum of adverse reactions to volatile anesthetics and succinylcholine in patients with myopathic disorders is presented and discussed. As in other case reports, the dramatic course described here also demonstrates that in addition to CPR and treatment of the acid-base and electrolyte imbalances, administration of dantrolene should be considered at an early stage.
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In the last 15 years, 124 children with a history and clinical signs of aspiration have been managed by emergency rigid endoscopy under general anesthesia. In 115 (93%) of them a foreign body could be identified, which was successfully removed by forceps extraction in 114. Only 1 patient required a thoracotomy for removal of a distally located aspirated needle. ⋯ In children with chronic endotracheal foreign bodies, in 80% a second endoscopy after 48 h was indicated, and the mean stay in hospital was extended to 7 days. Emergency rigid tracheobronchoscopy and forceps removal of aspirated foreign bodies under general anesthesia and with meticulous perioperative monitoring is a safe and effective procedure with no mortality. Even in suspected aspiration or chronic bronchopulmonary infections, liberal use of endoscopy is recommended.