Regional-Anaesthesie
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Regional-Anaesthesie · Oct 1987
Case Reports[Lumbar epidural hematoma and spinal abscess following peridural anesthesia].
Epidural application of local anesthetics or opiates is commonly used for treatment of severe pain or arterial obstruction. We discuss two cases of complications following peridural anesthesia. As an acute complication, a lumbar epidural hematoma developed hours after placement of the catheter and caused sciatic pain and nearly complete paraplegia. ⋯ The risk of infectious complications after long-term peridural catheterization may be up to 20%. Hematogenous metastatic infection is more common in patients with malignancies or multiple risk factors than continuous immigration of bacteria. Epidural hematomas and spinal abscesses can cause disability and persistent neurological deficit in spite of aggressive surgical and antibiotic therapy.
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For decades it has been known that the combined sciatic and femoral nerve block could be used for operations on the leg. Nevertheless, it is used in very few hospitals as a routine method for surgical anesthesia and only few publications exist in this area. To highlight some practical aspects, we have produced a retrospective study of 660 cases of femoral and sciatic nerve blocks used exclusively for operating purposes. ⋯ The most important factor influencing the failure rate was the anesthesiologist. The individual failure rate of the first 30 blocks of each anesthesiologist (V30) was nearly equal to the overall individual failure rate (Fig. 3). The form and time of premedication and the extent of sedation did not influence the results.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional-Anaesthesie · Oct 1987
[Effect of dihydroergotamine (DHE) on blood volume and circulation in the calf in peridural anesthesia in the human].
Dihydroergotamine (DHE) preferentially constricts capacitance vessels in the skin and striated musculature, thereby redistributing blood in favor of the pulmonary vascular bed in the presence of neurogenic vascular tone. The aim of this study was to see if DHE would act likewise when neurogenic vascular tone is absent. Filling and blood flow of the calves were measured plethysmographically in six healthy, supine male volunteers before and during peridural anesthesia (PDA) to the level of at least T5 and, in the denervated state, after the injection of DHE 7.5 micrograms/kg intravenously. ⋯ In the absence much as in the presence of neurogenic vascular tone, DHE preferentially constricts capacitance but not resistance vessels. Thus, DHE counteracts the vascular effects of PDA, as it improves cardiac filling and consequently raises arterial blood pressure by redistributing blood from the dilated capacitance vessels without curtailing blood flow. It would appear, therefore, that DHE is a rational alternative to fluid therapy for the prophylaxis of arterial hypotension during major conduction anesthesia.