Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Single-shot spinal anesthesia versus continuous spinal anesthesia using the CoSPAN catheter].
We compared conventional single-shot spinal anaesthesia (SS) with continuous spinal anaesthesia (CS) in a randomised prospective study. ⋯ Fractionated injection of the local anesthetic via a spinal catheter was more precise in achieving the desired maximum cephalad spread than SS. The CS group revealed a significantly more stable blood pressure than the SS group. The use of a short-acting local anesthetic for CS provided an earlier postoperative return of motor function of the legs. Postspinal headache appears not to be a clinically relevant problem when 28-gauge spinal catheters are used.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
Review[The role of mixed venous oxygen saturation in perioperative monitoring and therapy. A critical stock taking].
Since mixed venous oxygen saturation (SvO2) depends on O2-supply and O2-consumption, its measurement is said to indicate tissue O2-balance and to be suitable for ensuring tissue oxygenation in critically ill patients. Blood for SvO2 determinations should be drawn exclusively from the pulmonary artery, because mixing of systemic venous blood is incomplete in the right atrium and ventricle. SvO2 can be determined in vitro and in vivo. ⋯ Central venous oxygen saturation may indicate directional changes of the SvO2, but does not estimate the real SvO2-value. The hypothesis that continuous SvO2 measurements improve prognosis or lower treatment costs has not yet been confirmed. Measurements of mixed venous oxygen saturation may improve monitoring and treatment of critically ill patients in selected cases; however, these measurements are not suitable to indicate reliably the status of tissue oxygenation under all conditions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
Biography Historical Article[Arthur Läwen--a pioneer of modern anesthetic techniques].
The development of modern local anaesthetic techniques is connected with the name of Arthur Läwen. At the turn of this century, he started his surgical training with Heinrich Braun, who had performed a lot of research with various local anaesthetic methods and who was renowned world-wide as an authority for his contributions. It is not surprising that a main topic of Läwen's research was the development of new local anaesthetic regimes. ⋯ The further development of new techniques for the differential diagnosis of various illnesses must also be mentioned. A remarkable step towards a modern anaesthesia concept was the administration of curare for muscle relaxation in operative surgery. Another evidence of his foresight are his contributions in the development of an electrically driven apparatus to overcome respiratory failure "Läwen was in many ways a man before his time:" This appraisal by a surgeon colleague is true even today for several of his anaesthesia-related contributions, which are still part of the armamentarium of modern anaesthetic methods.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
[Mid-latency auditory evoked potentials during increasing doses of fentanyl].
Intraoperative awareness, and especially the perception of auditory stimuli occur occasionally under general anaesthesia with high-dose opioids. Mid-latency auditory evoked potentials (MLAEP) reflect the primary cortical processing of auditory stimuli. Hence, we studied the effects of fentanyl on MLAEP. ⋯ MLAEP and especially the primary cortical potentials Na, Pa, Nb did not change markedly in amplitude or latency during high-dose fentanyl analgesia. There is no dose-dependent effect of fentanyl on MLAEP as it can be observed under volatile anaesthetics (isoflurane, enflurane). The primary cortical processing of auditory stimuli can be completely blocked by volatile anaesthetics, but is still preserved under highest doses of fentanyl. This may be seen in connection with cases of awareness and perception of auditory stimuli during high-dose fentanyl analgesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1993
Review[Quantifying pathological disorders of consciousness. Reliability criteria, aims, feasibility].
Within a survey of coma scales we distinguish scales of clinical findings (Glasgow Coma Scale [GCS], Glasgow Liège Scale [GLS], Innsbruck Coma Scale [ICS], Comprehensive Level of Consciousness Scale [CLOCS]), grading tests (Vigilance Scale [VS], Funktionspsychose-Skala-B [FPBS-B]) and level-scales (Reaction-Level-Scale [RLS-85], Munich Coma Scale [MCS]). With regard to the purpose we differentiate a classification of depth, the prediction of prognosis and the monitoring of changes. For the purpose of classification of depth, the RLS-85 because of its superior objectivity is preferable, but the GCS is of comparable validity and more widely used. ⋯ The ICS is not widely used and the prognostic validity has not been proven to the same extent. The Glasgow-Cologne-List could be amplified for the less severe disturbances of consciousness according to Price (32,33), and for the lower levels according to the GLS (2,3,4). In both cases the expense is slightly higher.(ABSTRACT TRUNCATED AT 250 WORDS)