Praktische Anästhesie, Wiederbelebung und Intensivtherapie
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A method of spinal anaesthesia with Dixidextracaine-70 (a mixture of xylocaine 40.0 mg + percaine, 10.0 mg+ Dextran-70, 60,0 mg+ distiled water ad 2.0 ml) with continuous epidural block has been tested in 150 patients. The advantages of this association are: the possibility of obtaining a high quality conduction anaesthesia, virtually unlimited in time, the ability to extend over several anatomical regions the surgical field, minimal toxicity, the absence of postoperative pulmonary complications, and the economy. Drawbacks are: the need for two vertebral punctures, the longer induction time of anaesthesia and some difficulty in finding the subarachnoid space after catheterisation of the epidural space. The indications of the method include subdiaphragmatic surgery, interventions on more than one anatomical region, surgery in aging patients, patients with full stomach, and those with anaesthetic and surgical risk, as well as socioeconomic factors which may prevent application of a differentiated and safe narcosis. ⋯ those of subarachnoid and epidural block. The incidents and accidents are minimal and specific to both techniques. The fear of producing total subarachnoid anaesthesia by injection of the anaesthetic solution in the epidural space after puncture of the subarachnoid space is virtually unfounded.
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Clinical Trial Controlled Clinical Trial
[The influence of sedation with diazepam and flunitrazepam during regional anaesthesia upon postoperative pulmonary performance (author's transl)].
In 32 patients between 53 and 86 years of age, undergoing transurethral prostatectomy, the influence of intraoperative sedation with Diazepam (5-10 mg) and Flunitrazepam (0,4-0,8 mg) on postoperative forced vital capacity, forced exspiratory volume (1 sec.) and peakflow, were measured, compared to placebo. We could not find a depression of these ventilatory parameters, in the three groups except peak-flow after sedation with Flunitrazepam in the evening after operation (p less than or equal to 0,05). We conclude that sedation during regional anesthesia does not impair the most important advantage of local anesthesia, the minor effect on ventilation, compared with general anesthesia.
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Central venous pressure was measured in 34 persons who had transurethral prostatectomy in general or regional anaesthesia. The aim of the investigation was to ascertain to what extent measurement of the central venous pressure as a parameter of blood volume can help towards the early diagnosis of hypervolaemia caused by the leakage of irrigation fluid into the patient's circulation. ⋯ The less severe reaction during regional anaesthesia on the circulation is probably attributable to a sympathicolytic effect and peripheral pooling. The early detection of the leakage syndrome is easier in the conscious patient.