Langenbecks Archiv für Chirurgie
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Because of our own experiences with more than 10,000 cases of spinal anesthesia without neurologic complications, it is emphasized that the method has regained clinical importance due to modernized techniques, new local anesthetics (lidocain, mepivacain, bupivacain), and a better understanding of the pathomechanisms involved. Restricting the spinal block to the D 8 dermatome level, thus avoiding side effects, and sticking to a clear-cut range of contraindications renders spinal anesthesia a method that compares favorably with that of general anesthesia in the high-risk patient.
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Langenbecks Arch Chir · Nov 1977
[Interdisciplinary limits of jurisdiction and responsibility from a legal viewpoint (author's transl)].
In the interdisciplinary cooperation between the surgeon and the anesthetist, the following factors are in effect: the principle of strict division of labor; each brings the functions of his specialty and carries complete responsibility for them; the principle of trust: each can depend on the meticulousness of the other, as long as no obvious qualification deficiencies are apparent; obligation for coordination: each must accommodate himself to the requirements of the other specialty.
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Experiences, with about 1500 cases of intravenous regional anesthesia in outpatient surgery of the limbs over 10 years are reported. In 1975, 158 operations out of 5960 were done using this technique. ⋯ Contraindications for this type of anesthesia are hypertonia, lack of accessible veins, heart failure, children, as well as surgery of undefinite extent or for local sepsis. When these rules were followed, no serious complications were seen.
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Langenbecks Arch Chir · Nov 1977
[Regional anesthesia today--possibilities and limits: introduction (author's transl)].
The various procedures of regional anesthesia were widely used before the introduction of intratracheal anesthesia; thereafter, it was replaced by the today commonly used general anesthesia. Regional anesthesia nonetheless plays an important role, primarily in outpatient treatment, because a large number of surgical departments still have no anesthesiologist on the staff. Often the surgeon is responsible for both the operation and the anesthesia. Indications, risks, and complications including legal problems related to regional anesthesia are discussed.
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There is a great difference in the internal fixation of infant and adult fractures. Biological and anatomical pecularities in childhood make it possible for lingitudinal growth to be impaired by the implanted material, its size, its topographic relationship to the growth organ and the duration of implantation. ⋯ Various ASIF techniques, such as Kirschner wiring, screwing, and fixation with plates, are suitable. Medullary nailing (Küntscher) should not be used in children.