Der Anaesthesist
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A radiological study was made in 33 patients of the position of the epidural catheter and the spread of the contrast medium Metrizamide (Amipaque) when used in volumes of 10, 15 and 20 ml. The puncture at the interspinal space L2/L3 and L3/L4 allows the safe inclusion of eight peridural segments in all cases, whereas puncture of the upper regions of the spine results in a less predictable effect with spread of the injected fluid to higher spinal segments. A larger volume of contrast medium of 15 ml allows the safe inclusion of a larger number of spinal segments. Abnormal presentation, areas of fluid loss and the distribution of the analgesics or local anaesthetics injected may be detected early, which allows correction or adaptation of decisions concerning the fluid volume or the concentration of analgesics such as morphine.
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Malignant hyperthermia (MH) is a rare syndrome seen when susceptible individuals are exposed to one or more of various triggering agents, most commonly a depolarizing muscle relaxant or an inhalational anaesthetic agent. There is a dramatic rise in metabolic rate and oxygen consumption which if not treated promptly and effectively results, in the majority of cases, in the patient's death. Fatal responses to physical stress associated with the familial muscular disease known as MH are being increasingly reported in situations not related to anaesthesia or drugs. ⋯ Evaluation of affected families is guided by in vitro analysis of drug-induced contractures in muscle biopsy specimens; a practical and reliable non-invasive test to predict the susceptibility is still being sought. At the present time there is incontrovertible evidence that the hydantoin derivate dantrolene sodium is the only known specific drug in treatment and prophylaxis of MH. A concept for the treatment of MH and guidelines for the management of a patient at risk are presented; medico legal aspects of the complication are stressed.
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Comparative Study
[Anesthesia procedure and postoperative ADH secretion].
44 patients undergoing major abdominal and thoracic surgery received different anaesthetic treatment and different pain therapy during the postoperative period (4 groups). Analysis of plasma vasopressin was performed in all patients pre-, intra- and five days postoperatively. ⋯ During the postoperative period pain relief was provided by giving fentanyl epidurally (group B and D) or with systemic administration of piritramide (group A and C). During the investigation period vasopressin secretion in patients under epidural opiate therapy was significantly less pronounced as in patients under systemic opiate therapy.
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It is reported that the catheterization of the internal jugular vein in patients with severe coagulopathies had fatal consequences. The catheterization was done with a Sheldon-catheter for dialysis. The technique of Seldinger was performed, which has been described for morbid patients in most literatures.
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In the case of patients with unilateral lung disorders one must anticipate a further increase in the intake volume of the more elastic lung and a decrease in intake volume of the less elastic lung when the inspiratory pressure is increased or the inspiratory time is extended within the framework of mechanical ventilation. Therefore, differential pulmonary ventilation lends itself for the treatment of unilateral damage of the lung by enabling the selective application of a positive end-expiratory pressure or an inverse inspiratory time. For a better understanding of the overlapping pathophysiologic reactions, the changes in lung mechanics, haemodynamics and gas exchange were measured on the healthy lung with unilateral application of a positive and expiratory pressure or an increased inspiratory time. ⋯ The respiratory intake volume was divided up into 45% (left lung) and 55% (right lung) based on the physiological difference in size between the left and right lung. Our results show that a directed unilateral application of a positive end expiratory pressure or an increased inspiratory time does not have any relevant damaging effects on the other lung. It can be expected that in the case of non-differentiated mechanical ventilation the ensuing unequal distribution of alveolar ventilation and perfusion with consecutive increase of intrapulmonary shunt volume can be decreased by the discriminate treatment of each lung.