Zentralblatt für Gynäkologie
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667 cases inclusively 27 twin-births are evaluated in a retrospective study on the anesthesias administered in cesarean section (CS) from 1975 to 1983. The applied induction anesthetics hexobarbital, ketamine (Ketanest), propanidid (Sombrevin), etomidate (Radenarcon) and epidural anesthesia with bupivacaine (Marcaine) have been compared with each other concerning the Apgar scores of the newborns. ⋯ This tendency is also preserved when only the primary CS are taken into consideration. Besides the indications for the single anesthetics and methods of anesthesia, respectively, reference is made to the positioning of the mother and the avoidance of aspiration in the introduction of the anesthesia.
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Experiences with intrathecal morphine analgesia in 36 patients undergoing Wertheim-Held hysterectomy are reported. Postoperative painrelief, bloodgas-parameters (pO2, pCO2, pH, SBE, SAT), analgetica demand, side-effects are compared with 23 patients of a control group. 95% of patients with intrathecal morphine analgesia were postoperatively without pain for at least 24 hours. ⋯ The incidence of nausea, vomiting and headache were not increased. Considering the not in all cases avoidable development of a respiration insufficiency even after a little dosis of morphine this method seems to be a suitable treatment of postoperative pain which enables the early mobilisation of the patients.
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There were 37 cases of prolapse of the umbilical cord among 16 177 deliveries (incidence of 0,2%). Therapy is firstly knee-chest positioning of the mother, control of fetal heart rate and acute tokolysis, secondly rapid delivery. The perinatal mortality of prolapsed cord was 13,5 per cent. Various methods of delivery are analysed.
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Lesions of the ureters and the bladder are represented with a relatively high portion of 40% within all gynaecological and obstetrical cases under expert opinion in the Central Office for Medical Expert Opinion. The so far mostly practisized judgement as an operational risk could not generally be consented. It is therefore that the Central Office for Medical Expert Opinion elaborated the directive No. 9: "Medical expert opinion of urological complications connected to gynaecological operations". ⋯ Experiences from expert opinion result in perceiving the following main points: Even in technically simple operations the operator must know the course of the ureter; 2. if its course is not clear it must be made visible dependent on the operational situation in each case; 3. the preoperative methods of urological diagnosis have to be appropriate to the intended operation; 4. even in smallest grounds for suspicion of a lesion or complication a consequent control is necessary; a detailed documentation of the operational course is needed for various reasons; 6. the correction of lesions of the ureters and the bladder requires experience and operational ability. Because of possible grave damages to the woman the operator must be conscious of the limits of his ability. Details are demonstrated by examples of the Central Office for Medical Expert Opinion.
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Lumbar epidural anaesthesia was applied for obstetric analgesia to 103 women, most of them primiparae. Three different concentrations of Bupivacain (Markaine) were used for local anaesthesia, percentages being 0.5, 0.375, and 0.25. ⋯ Frequency of caesarean sections as well as both the acid-base status and Apgar scores of the newborns were similar to those recordable from comparison groups. -- Advantages were clearly visible and side-effects of minor importance. Catheterisation for lumbar epidural anaesthesia, consequently, is recommended as an optional approach to obstetric analgesia.