Praktische Anästhesie, Wiederbelebung und Intensivtherapie
-
Two cases of anaesthesia-induced malignant hyperthermia are reported. One patient died; the other, a 29-years-old woman, recovered without ascertainable after-effects although high temperature persisted for a relatively long time. Suggestions for the early diagnosis of malignant hyperthermia are analysed and the problem of procaine dosage is briefly discussed.
-
After prolonged deliberations guide lines have now been agreed upon regarding the training and examination of nursing personnel for work in recovery and intensive care units. The recommendations, as adopted by the German Hospital Association 16th November 1976, cannot be accepted unreservedly. One of the main objections is that the proposed course of training would lead to excessive specialization at too early a stage. The aim should be to provide training of an interdisciplinary character, including anaesthesia.
-
Although the successful treatment of critically ill patients often depends on access to the large veins close to the heart, the indications for this procedure should be strictly limited on account of the attendant risks and potential complications. From the large variety of cannulas, catheters and techniques available for this purpose those systems should be chosen that are simple and safe to use. Seldinger's technique is the method of choice for elective puncture under optimum conditions. ⋯ The peripheral veins of the arm are the safest access for the less experienced physician and for short-lasting catheterization; otherwise the internal jugular vein is the preferred site followed by the subclavian vein. Even if the physician prefers a particular access route he should be familiar with all types of technique since critically ill patients are liable to require changes of the catheter. There is no single technique that will cover all contingencies.
-
The efficacy of peridural, spinal, and saddle-block technique in the operative treatment of the gravid patient is briefly described. Factors influencing height and spread of analgesia are indicated. ⋯ We discuss the operative possibilities with such techniques. In conclusion we describe the side effects encountered and their treatment.