Anaesthesiologie und Reanimation
-
Anaesthesiol Reanim · Jan 2002
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative studies of patient positioning for lumbar intervertebral disk operation].
For surgery on lumbar disks by the posterior route, patients are placed either on a Wilson frame or in genupectoral position. The aim of the prospective study was to record and describe the haemodynamic changes resulting from the patients' position. After written informed consent had been received, 80 neurosurgical patients undergoing lumbar disk surgery were randomly divided into two groups; group I--Wilson frame, group II--genupectoral position. ⋯ We recommend the Wilson frame for neurosurgical lumbar disk surgery in cases of cardiovascular or cerebrovascular disorders. The adaptive capacities in the genupectoral position as a result of the modifying distribution of blood volume are limited in these patients. Furthermore, the dose-dependent effects of different anaesthetics on haemodynamic parameters in these prone positions should be explored.
-
Myocardial ischaemia/reperfusion situations may occur during the perioperative period. The cardioprotective effects of anaesthetics have been known for a long time: volatile anaesthetics reduce the ischaemic cell damage and infarct development. Besides ischaemia, reperfusion itself can also lead to cellular damage, thereby further increasing the ischaemic injury (reperfusion injury). ⋯ The common pathway of the signal transduction cascade of both ischaemic and chemical preconditioning includes the sarcolemnal and/or mitochondrial ATP-sensitive potassium channel. Volatile anaesthetics can imitate the protective effects of a short ischaemia, thereby producing chemical preconditioning. This effect depends, at least in part, on anaesthetic-induced opening of ATP-sensitive potassium channels.
-
Anaesthesiol Reanim · Jan 2002
[Quantitative assessment of neuromuscular block of the orbicularis oculi muscle].
In a prospective clinical study neuromuscular block at the orbicular ocular muscle was examined qualitatively and quantitatively by an AMG approach. The signals were recorded, visualized and evaluated simultaneously under PC-support after TOF-stimulation in 20 s intervals. Fifty ASA I and II patients were included into the study. ⋯ Additional problems arise through the considerable temporal expenditure for discovering the optimal location of stimulation. During the AMG monitoring the position dependence of the measured values of the sensors must be taken into consideration. These technical problems restrict the suitability of the AMG at the orbicular ocular muscle as a quantitative neuromuscular monitoring tool.
-
Anaesthesiol Reanim · Jan 2002
Review[Etiology and sequelae of perioperative accidental hypothermia].
Accidental hypothermia is a frequent event during the perioperative period. Recent studies revealed a drop in core temperature of over 2 degrees C in more than 50% of all patients undergoing an operation. This drop in core temperature seems to be primarily due to the following factors. ⋯ On the other hand, there is accumulating evidence that accidental perioperative hypothermia may also adversely affect organ function and outcome. For example, unfavourable effects of perioperative hypothermia on the immune defence, on the function of the coagulation system, on cardiovascular performance, as well as on postoperative recovery have been reported. Consequently, measures should be taken to actively control the perioperative heat balance of patients.
-
Anaesthesiol Reanim · Jan 2002
Case Reports[Critical infusion incident caused by incorrect use of a patient-controlled analgesia pump].
We report on the case of a 17-year-old male patient who received a PCA pump after nephrectomy for postoperative analgesia. The syringe of the PCA pump was filled with 50 mg morphine and positioned about 25 cm above the heart. Since the piston of the syringe was not bolted while the pump was switched off, an unnoticed accidental evacuation of the whole content of the syringe into the intravenous line of the patient occurred because of gravity. ⋯ This critical incident was caused by various factors: incorrect application in combination with insufficient experience or training, stress, inadequate handing-over of the patient and a lack of arrangements and instructions for procedures in routine situations. Suggestions for preventing such dangerous critical incidents are made and discussed. In particular, an algorithm for the correct procedure when inserting or changing the syringe of a syringe pump is presented.