Regional-Anaesthesie
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Regional-Anaesthesie · Apr 1988
Randomized Controlled Trial Clinical Trial[Clinical effectiveness and systemic toxicity of various mixtures of prilocaine and bupivacaine in axillary plexus block].
The presently existing local anesthetics (LA) do not guarantee a rapid onset and simultaneously a long duration of action. The combination of a medium-long acting LA with bupivacaine, a long-acting LA with slow onset, could be means to achieve these aims. Prilocaine was chosen as the medium-long acting LA because it has the lowest toxicity of this group and for pharmacological reasons. ⋯ Forty minutes after injection there were no significant differences between the groups. Motor blockade after 20 min was significantly lower in the bupivacaine group than in the prilocaine group (P less than 0.05). After 4 h all three prilocaine-bupivacaine mixtures showed a significantly more pronounced analgesia of the median nerve than the prilocaine group (P less than 0.02-0.001).(ABSTRACT TRUNCATED AT 400 WORDS)
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Regional-Anaesthesie · Jan 1988
Case Reports[Anesthesiologic management of cesarean section in a patient with transposition of the great vessels].
The maternal mortality associated with cesarean section in the presence of congenital cyanotic heart disease is high. We report the anesthetic management of a 26-year-old pregnant patient with transposition of the great vessels and a functional single ventricle whose child was delivered by elective cesarean section under continuous epidural anesthesia. ⋯ The cooperation of cardiologists, anesthesiologists, and obstetricians was necessary to assure maternal and fetal survival. Continuous invasive hemodynamic monitoring and use of small epidural top-up doses (2-3 ml) of local anesthetic were of utmost importance in maintaining the hemodynamic stability.
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Regional-Anaesthesie · Jan 1988
[Axillary blockade of the brachial plexus. A prospective evaluation of 1133 cases of plexus catheter anesthesia].
The results of 1133 axillary catheter brachial blocks are reported. Effectiveness and side-effects were monitored in a prospective manner over a period of 1 year. ⋯ Surgery was completed in 72% of patients; 24% required some form of supplementation including 17.2% of patients who received a "top-up" after 20 min (Table 1). In 3.8% of cases the technique was considered to be a complete failure, meaning that patients needed some type of general anesthesia including the use of i.v. ketamine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional-Anaesthesie · Jan 1988
Case Reports[Epidural hematoma following epidural catheter anesthesia in thrombocytopenia].
We report a 21-year-old male patient suffering from acute myeloid leukemia and concomitant thrombocytopenia. Following a diagnostic thoracotomy-which revealed Aspergillus pneumonia-he developed respiratory insufficiency and dyspnea. A thoracic epidural catheter was inserted and epidural morphine treatment led to improved ventilation. ⋯ The development of epidural infection or hematoma seems to be a possible complication of epidural analgesia in patients suffering from impaired defense mechanisms or thrombocytopenia. These risk factors should be taken into account when epidural analgesia is considered. We suggest that the platelet count should be determined beforehand in patients suspected of having thrombocytopenia (e.g. cancer, pre-eclampsia).
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Regional-Anaesthesie · Jan 1988
[Combined sciatic nerve/3-in-1 block. I. Dose determination for CO2-lidocaine 1.1%].
The goal of this open-labeled clinical study on 30 patients was to find out which dosage of CO2-lidocaine 1.1% (= lidocaine HCl 1%) would provide clinically acceptable analgesia for surgical procedures on the lower extremities under combined sciatic-femoral block. A first group of 5 patients was given a dose of 330 mg = 30 ml (15 ml to block the sciatic nerve and 15 ml for the 3-in-1 block), the maximum dose allowed by the manufacturer. This dosage did not result in any degree of satisfactory block and all patients had to be operated upon under general anaesthesia (GA). ⋯ Only in the third group of 10 patients, who were given 550 mg = 50 ml (sciatic nerve: 20 ml; 3-in-1 block: 30 ml) was a clinically acceptable success rate achieved; there was only 1 patient who needed light GA for supplementation. In group I (330 mg) only partial sensory blockade was achieved (after approx. 5 min); the femoral and lateral femoral cutaneous nerves could not be blocked in any patient, and motor blockade was present in only 1 patient. In group 2 (440 mg) the onset of sensory block began after 5 min, was complete by 11 min, and in 6 of 15 patients (= 40%) motor blockade was achieved.(ABSTRACT TRUNCATED AT 250 WORDS)