Praktische Anästhesie, Wiederbelebung und Intensivtherapie
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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.
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A technique for continuous block of the brachial plexus is described using an indwelling teflon cannula positioned according to the anatomical dictates of the supraclavicular and interscalene spaces. The anatomy is presented as key to consistent results. Advantages of a continuous block are an extension of normal block duration, block placement independent of operating times and a possible application to intensive care patients.
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The risks attendant on regional anaesthesia derive from the condition of the patient, the technique employed and the skill, or lack of skill, on the part of the anaesthetist. Patient-determined risk factors are: existent diseases and pathological conditions which in many cases cannot be rectified pre-operatively. ⋯ Each technique carries its own specific risk. With due care many of the complications can be prevented.
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The decision regarding fitness of a person to undergo surgery and anaesthesia is made by the surgeon and anaesthetist according to agreed criteria. The physician takes part in the decision only in those cases where additional information regarding the type and extent of the disorder is required or when doubtful findings need further clarification. Closer co-operation between anaesthetist and physician regarding the indications for pre-operative tests and investigations is desirable.
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Controlled respiration should have a place not only in cases of hypoventilation but also in the treatment of comatose and hyperventilating persons. Hyperventilation is liable severely to interfere with the blood supply to the brain, and this disturbance, in conjunction with the primary disease responsible for the comatose condition, such as hyperglycaemia, diabetes or cerebral trauma, may be a contributing factor to the lethal outcome. Controlled respiration helps towards regulation of the cerebral circulation and of the acid-base balance and provides improved conditions for normalization of the disturbed metabolism and thus greatly improves the prognosis of these cases.