Regional-Anaesthesie
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Regional-Anaesthesie · Jul 1989
[Initial experiences with a novel nerve stimulator for use in axillary plexus anesthesia].
The advantages of an electrical nerve stimulator for detection of the axillary neurovascular sheath have been frequently described in the literature and are now well known. In most of these techniques, stimulation is achieved by a fixed electrical voltage and variable amplification. The new nerve stimulator presented here offers the possibility of measuring the current at the site of stimulation ("test" position). ⋯ Thus, disturbances in the circuit between nerve stimulator and patient, as shown in the two cases, can be detected. According to our experience, the intensity of stimulation for successful nerve blockade should be approximately 0.5 mA or lower. Consequently, universally applicable stimulating instruments with constant electrical tension should allow fine tuning of the current in 0.1-mA aliquots.
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Regional-Anaesthesie · Jul 1989
Case Reports[Epidural anesthesia and local administration of high-dose prostaglandin in obstetrics. A dangerous combination].
The use of high epidural anesthesia for cesarean section has generally been accepted as a safe and comfortable means of intra- and post-operative pain relief in recent years. However, the accompanying vasomotor blockade of the lower body and the sometimes impaired cardiac reflex activity restrict the use of concomitant--even local--medication. ⋯ Differentiation of the various symptoms is made in relation to their epidural or PGE origin or to a combination of the two. A striking therapeutic resistance of the hypotension of a sufficiently volume-expanded patient to even large doses of ephedrine is discussed as representing possible PGE-mediated suppression of peripheral norepinephrine release.
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Regional-Anaesthesie · May 1989
[Does the development of methemoglobin in the newborn infant affect the suitability of prilocaine for pudendal anesthesia? A clinical study in the peripartum phase].
Pudendal block is a well established method of achieving analgesia during the second stage of labor. Whenever a large amount of a local anesthetic has to be injected in well vascularized tissue, local anesthetic drugs with low systemic toxicity should be used, to minimize side effects. This means that prilocaine is the drug of choice. ⋯ Formerly prilocaine was judged to be contraindicated in pregnant women during delivery because of the small redox capacity of fetal erythrocytes. Our study, however, demonstrates that 200 mg prilocaine for pudendal block does not induce methemoglobinemia in newborns to any significant extent. One explanation for this may be the increased renal elimination of local anesthetics in newborns and the low fetomaternal ratio.
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Regional-Anaesthesie · Mar 1989
Case Reports[Chronic subdural hematoma following spinal anesthesia].
A chronic subdural hematoma was observed 4 weeks after spinal anesthesia. The 70-year-old patient complained of severe, long-lasting headache soon after lumbar puncture. The later symptoms of hemiparesis and aphasia were first misinterpreted as a cerebral vascular accident. ⋯ Because this complication is so rare informing the patient before spinal anesthesia does not seem to be necessary. According to expert opinions, a connection between lumbar puncture and subdural hematoma should be possible. In elderly patients and alcoholics, a pre-existing subdural hematoma may be possibly present.