Der Anaesthesist
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A cost-effective computer program for district hospitals has been developed to process data from anesthetic charts. Apart from monthly and annual statistics relevant to clinical anesthesia and hospital administration, the described system allows free data handling of all material stored in the data base. The possibilities and limitations of electronic data processing are discussed.
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To determine how pain is assessed and managed in the early postoperative period, what the prescribing habits and general opinions on postoperative pain are, and what suggestions for future improvement could be made, questionnaires were sent to 430 anesthesia departments in the FRG. Of these, 188 were returned (38% response). ⋯ The study highlighted deficiencies in communication between the anesthetic staff and the patients that resulted in poor assessment of acute pain problems. The findings indicate a need to document pain and pain relief more often and more precisely in order to improve postoperative pain control.
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Invasive blood pressure monitoring is increasing in anesthesia and intensive care. Compared to noninvasive methods, it has some decisive advantages: (1) blood pressure trends can be assessed beat by beat, which is important especially in situations of cardiac arrhythmia; (2) respiratory changes in blood pressure as one sign of hypovolemia can be detected easily; and (3) pressure changes induced by the autonomic nervous system become apparent. We studied a new, reusable pressure transducer system, the Medex Novatrans-MX800 in routine intra- and postoperative monitoring of patients undergoing cardiac surgery using the following criteria: (1) handling; (2) accuracy of measurement; (3) durability; and (4) costs. ⋯ Two transducers showed errors of measurement over 5% after 60 times of reuse. The mean reusability rate until the transducer became defective was 75.8 +/- 17.3 in the operating room (19 transducers tested) and 59.7 +/- 29 in the intensive care unit (12 transducers tested, 11 still in use). A comparison of costs shows that the Novatrans-MX800 system is the cheapest system for invasive pressure monitoring available at this time.
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To study the problem of rapid antagonization of an intubation dose of vecuronium (0.08 mg/kg), 36 surgical patients undergoing barbiturate/halothane anesthesia were given edrophonium 0.5, 0.75, and 1.0 mg/kg or neostigmine 0.04, 0.06, and 0.08 mg/kg precisely 5 min following injection of the muscle relaxant. T1 twitch (T1/Tc) and train-of-four (TOF) ratios (T4/T1) of the hypothenar muscle were monitored every 20 s with the aid of a commercially available EMG monitor (Datex-Relaxograph). As documented by T1 and T4/T1 follow-up curves (Figs. 1 and 2) and derived parameters of relaxation as well (Dur25, Dur50, Dur75, recovery index, and reversal time; Table 4), both edrophonium and neostigmine resulted in a significantly shorter duration of vecuronium blockade (P less than 0.001). ⋯ Recurarization did not occur. Differences between drugs and dose-dependent effects were minimal; edrophonium did not prove superior to neostigmine with the exception of less pronounced muscarinic side effects, hence less bradycardia and a minimum heart rate of 57 +/- 8.2 bpm 20 min after the injection of neostigmine as opposed to 72 +/- 8.2 bpm following edrophonium (P less than 0.05; Fig. 4). As to the restitution of a ventilatory force sufficient to allow spontaneous breathing, no definite conclusions can be made.(ABSTRACT TRUNCATED AT 250 WORDS)
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In 60%-90% of cases head injury is a part of multisystem trauma and of very decisive importance for the post-traumatic prognosis. Hypoxia, hypercarbia, and hypotension increase the primary lesion and cause secondary brain damage. Therefore, emergency measures must be directed to the essentials of sustaining vital functions, i.e. intubation/ventilation/oxygenation and stabilization of the circulatory system. ⋯ Anesthesia in patients with severe head injury must involve only those techniques that do not further increase an already elevated intracranial pressure. As inhalational anesthetics, including nitrous oxide, elevate the intracranial pressure to varying extents due to cerebral vasodilation with a concomitant rise in intracranial blood volume, these substances have to be avoided whenever raised intracranial pressure cannot be excluded. Narcotics, benzodiazepines, small dosages of barbiturates, and long-lasting muscle relaxants can be regarded as useful.