Regional-Anaesthesie
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Regional-Anaesthesie · Apr 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Combined ischiatic/3-in-1-block. II. 1 percent mepivacaine HCl versus 1 percent CO2 mepivacaine].
In a prospective randomized study on 26 patients, the clinical effectiveness CO2-mepivacaine 1% (group 1, 13 patients) and mepivacaine HCl 1% (group 2, 13 patients), was tested in patients having a sciatic-femoral block for surgical procedures of the lower extremity (20 ml for sciatic and 30 ml for 3-in-1 block). Blood levels of mepivacaine were determined for up to 90 min in 8 patients from each group. The onset of sensory and motor blockade was slightly earlier (4-5 min) with CO2-mepivacaine than with the hydrochloride (5-6 min). ⋯ There was a relatively large variance in intensity of blockade that was not necessarily related to the drug employed, but can be explained by individual factors and possibly by slight differences in blocking technique. Nevertheless, the rate of unsuccessful blockade was remarkably higher (38%) with the hydrochloride than with CO2-mepivacaine (7.7%). Determinations of blood levels did show the expected earlier peak (after 20-30 min) and higher blood-levels (means 3.8 micrograms/ml at 30 min) with CO2-mepivacaine 1% as compared to mepivacaine HCl 1%: 2.9 micrograms/ml at 30 min and 3.4 micrograms/ml at 45 min.
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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
Comparative Study[Comparison of bupivacaine hydrochloride 0.5% and bupivacaine carbonate 0.5% in interscalene plexus anesthesia].
Carbonated local anesthetics are less acidic than the hydrochlorides and require less buffering by the tissues. Rapid buffering and diffusion of the carbon dioxide enables free base to be deposited in high concentrations on nerve fibres. Carbon dioxide increases the intracellular hydrogen ion concentration, thus increasing the amount of active cation at the receptor site. ⋯ The first analgesia was detected by pinprick 5.1 +/- 0.4 (SE) min and complete analgesia in 19 +/- 1 min after bupivacaine hydrochloride and 4.7 +/- 0.5 min and 15 +/- 1 min after bupivacaine carbonate. The more caudad nerves showed a significantly longer latency time than the more cephalad ones. The duration of sensory analgesia varied between 6 and 12 hours, the more caudad nerves showing the shortest duration.(ABSTRACT TRUNCATED AT 250 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)