Regional-Anaesthesie
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Regional-Anaesthesie · May 1991
Case Reports[Subarachnoid placement of a peridural catheter with high spinal anesthesia. The advantage of 0.25 % bupivacaine].
A 72-year-old female patient was scheduled for abdominal surgery with epidural block in combination with general anesthesia. An 18 G epidural catheter was inserted through an 18 G Tuohy needle between T12 and L1 using the midline approach and the 'loss of resistance' technique. A test dose of 13 ml bupivacaine 0.25% showed no effect and a bolus of 12 ml bupivacaine 0.25% was added 8 min later. ⋯ A spinal X-ray with radiopaque dye showed a typical intrathecal distribution. Most remarkable in this case is the stability of the cardiovascular function which in our opinion is related to the 0.25% solution. Serious complications of an inadvertent dural puncture can be avoided or alleviated with this concentration if the epidural block is to be combined with general anesthesia.
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Regional-Anaesthesie · May 1991
[Intrathecal opiate-spinal anesthesia. Clinical results of a 1-year study using 0.0375-0.15 mg morphine].
In a prospective study, 184 patients were studied after orthopedic operations with regard to analgesic requirements, analgesic effectiveness, and appearance of postoperative complications. In four groups, 0.0375, 0.075, 0.1 or 0.15 mg morphine was given in combination with 0.5% hyperbaric bupivacaine for perioperative analgesia. The patients' ages ranged between 13 and 90 years (means = 62.97). ⋯ The application of small doses of opiate close to the spinal cord produced a good and long-lasting reduction of pain with few opiate side effects. In the spinal anesthetics with larger doses of morphine, side effects were rare and hardly different from those accompanying spinal anesthesia without morphine addition. There were no serious complications noted during the opiate anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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From the psychological point of view, regional anesthesia is something special because the patient experiences his operation consciously. This means that the anesthetist is required not only to guarantee a safe anesthetic, but also to recognize the special needs of the patients, to enter into them adequately, and thus to support the patient's own strategies for coping with his situation. The question arises as to what extent the anesthetist's behavior meets the patient's psychological requirements. ⋯ There were not many attempts by the physician to also deal with the patient's psychic state. On the while, communication was concerned with the quick and easy performance of anesthesia. This was also demonstrated by the fact that conversation between the anesthetist and the patient was nearly absent during the operation.
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Regional-Anaesthesie · Jan 1991
Randomized Controlled Trial Clinical Trial[The effect of 6% (40/0.5) hydroxyethyl starch and Ringer's lactate on blood coagulation, laboratory parameters and circulation during peridural anesthesia].
We investigated the effects of 6% hydroxyethyl starch (HES 40/0.5) and lactated Ringer solution (LRS) on blood coagulation tests and laboratory parameters during epidural anesthesia. Additionally, the efficacy of this prophylactic intravenous fluid supply in preventing sympathetic blockade induced hypotension was studied. METHODS. ⋯ The temporary increase in plasma volume after infusion of 6% HES 40/0.5 results in a greater hemodilution with a concomitant decrease of blood viscosity and improved microcirculation flow. These might be of interest in prevention of thromboembolic complications. The specific effects of the two solutions were also determinable during epidural blockade.
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Regional-Anaesthesie · Jan 1991
Randomized Controlled Trial Clinical Trial[Alkalinization of mepivacaine for axillary plexus anesthesia using a catheter].
One disadvantage of perivascular axillary block using a catheter technique is delayed temporal development of the blockade. Some clinical studies have concluded that pH-adjusted solutions of local anesthetics produce a more rapid onset of blockade. Alkalinization of mepivacaine for brachial block produced conflicting results. ⋯ RESULTS. The bicarbonate and saline groups were similar with respect to age, height, weight, and sex distribution. Significantly more patients in the bicarbonate group showed onset of motor blockade (grade 1) after 2 min with respect in the axillary, musculocutaneous, radial, and median nerves as well as onset of sensory blockade in the same nerves with a significant difference in blockade of the radial nerve. (ABSTRACT TRUNCATED AT 400 WORDS)