Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[The effect of thoracic epidural anesthesia on the pathophysiology of the eventration syndrome].
Abdominal mesenteric traction (MT) results in decreased mean arterial pressure (MAP), systemic vascular resistance (SVR) and increased cardiac output (CO). This response is induced by a considerable release of prostacyclin (PGI2). Precipitous falls in systemic arterial pressure related to central and/or autonomic nervous reflex arcs also have been described during operations on the upper abdominal viscera. ⋯ Our data clearly indicate that the mesenteric traction response consists in relevant haemodynamic alterations and a significant decrease of paO2. Stable haemodynamics and paO2 following cyclooxygenase inhibition signify an action mediated by prostacyclin. Deafferentation of the splanchnic nerves by supplementary thoracic epidural anaesthesia did not influence either prostacyclin release or the decrease in blood pressure and paO2 after traction on the mesentery root...
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Various new muscle relaxants are available: atracurium, rocuronium and vecuronium all have an intermediate duration of action, whereas doxacurium and pipecuronium are long-acting and mivacurium is a short-acting nondepolarizing muscle relaxant. The duration of action of atracurium and mivacurium is determined by their degradation, which makes them unique among the nondepolarizing muscle relaxants in this respect. ⋯ Because recovery from them is slow, long-acting agents should preferentially be used only when postoperative mechanical ventilation is intended. The use of a peripheral nerve stimulator is the only reliable guide to appropriate administration of muscle relaxants.
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The formation of an epidural or subdural haematoma is a well-known but very rare complication when anaesthetic procedures are conducted near the spinal cord. The major reasons are impaired blood coagulation and the trauma of puncture, which represents the initiating factor and determines the extent of the vascular lesion, while defective coagulation may cause the bleeding to continue. We report on a 30-year-old slender female patient of ASA group II undergoing epidural anaesthesia at L3/4 with a 19-gauge Crawford needle for an ankle joint injury. ⋯ Subsequently, there were no complaints at all, as proved by an investigation one year later. Unfortunately, the patient refused to undergo another MRT at that time. In the present case the haematoma was caused by tissue trauma due to several puncture attempts.(ABSTRACT TRUNCATED AT 250 WORDS)
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Documentation of physician-staffed ambulance runs traditionally focuses on information transfer between the prehospital care provider and the receiving hospital. To use this information as a tool for research and quality assurance programs, the German Interdisciplinary Association of Critical Care Medicine developed in a consensus process a protocol for nationwide use. Protocol development was based on the question of what information can be obtained reliably in the emergency medical service (EMS) environment and what questions should be answered by data analysis. ⋯ For data collection, the concepts of manual processing versus optical scanning are evaluated. The data analysis can serve as a basic tool for screening structure and process quality of EMS systems on a local as well as a nationwide level. During this process, areas for improvement as well as for clinical research are identified.