Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of propofol on vomiting after strabismus surgery in children].
Strabismus surgery in children is associated with a high incidence of postoperative nausea and vomiting (PONV). METHODS. ⋯ All patients were mechanically ventilated during anaesthesia and gastric contents were aspirated. Recovery scores were calculated for 2 h, emetic scores for 24 h postoperatively.
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Case Reports
[Inadvertant suture fixation of a Swan-Ganz catheter to the pulmonary artery following heart surgery].
We report a patient undergoing redo cardiac surgery for combined replacement of the aortic and mitral valves. During the course of the operation, a Swan-Ganz catheter - positioned preoperatively - was accidentally fixed to the wall of the pulmonary artery. As this did not interfere with cardiac output measurement or the pulmonary artery pressure wave form, the fixation was not noticed until an attempt was made to remove the catheter. ⋯ The patient required a sternotomy to remove the catheter. In order to avoid this complication, the indications for pulmonary artery catheters during cardiac surgery should be carefully considered. If catheters are inserted, their mobility should by all means be ensured before the chest is closed.
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Various in vitro models have been introduced for comparative examinations of post-dural-puncture trauma and measurement of liquor leakage through puncture sites. These models allow simulation of subarachnoid, but not of peridural, pressure. A new two-chamber-model realizes the simulation of both subarachnoid and peridural pressure and allows observation of in vitro punctures with video-documentation. Frame grabbing and (computer-aided) image analysis show new aspects of spinal puncture effects. Therefore, post-dural-puncture trauma and retraction can be objectively visualized by this method, which has not previously been demonstrated. ⋯ The two-chamber-model presented allows easy simulation of physiological subarachnoid and peridural pressure. The Ringer lactate solution in the subarachnoid chamber corresponds to the liquor, whereas that in the peridural chamber corresponds to the intercellular (peridural) space. The tension of the dural patch between the polyamide seals is similar to the situation in an anotomical model observed by spinaloscopy (in an earlier study). With the video documentation and computer-aided analysis technique introduced, dural trauma and retraction of the puncture site can be examined and demo
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The needle type introduced by Edward Tuphy for continuous spinal anaesthesia in 1944 is still used as the standard instrument for epidural anaesthesia up to the present day. Puncture of the dura and severance of the epidural catheter are the typical, though fare, complications of this procedure, giving rise to most of the actions brought for damage suffered during obstetric anaesthesia. The cerebral spinal fluid loss caused by thick needles can have serious consequences, including subdural and intracranial haematoma, cranial nerve pareses, labyrinthine hearing impairments and pneumocephalus. ⋯ For continuous spinal anaesthesia this needle has been available without the modified opening geometry since 1989 in sizes 22 G and 24 G and is wide by used in Europe. CSE technique with special and standard Sprotte needles. Spinal analgesia or anaesthesia) can be performed with the special needle and 123-mm-long 27 G or 29 G standard Sprotte needles before placement of the peridural catheter.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Fructose vs. glucose in total parenteral nutrition in critically ill patients].
Parenteral nutrition required following surgery or injury should not only meet post-aggression caloric requirements but also match the specific metabolic needs so as not to worsen the metabolic disruptions already present in this situation. The primary objective of parenteral nutrition is body protein maintenance or restoration by reduction of protein catabolism or promotion of protein synthesis or both. Whether all parenteral energy donors, ie., glucose, fructose, other polyols, and lipid emulsions, are equally capable of achieving this objective continues to be a controversial issue. The objective of the present study was to answer the following questions: (1) Do glucose and fructose differ in their effects on the metabolic changes seen following surgery or injury, the changes in glucose metabolism in particular? (2) Can the observation of poorer glucose utilization in the presence of lipids be confirmed in ICU patients? ⋯ As demonstrated, parenteral fructose, unlike parenteral glucose, has a significantly less adverse impact than glucose on the glucose balance, which is disrupted initially in the post-aggression state. In addition, the less pronounced increase in insulin activity during fructose infusion than during glucose infusion can be assumed to facilitate mobilization of endogenous lipid stores and lipid oxidation. Earlier workers pointed out that any rise in free fatty acid and ketone body concentrations in the serum produces inhibition of muscular glucose uptake and oxidation, and of glycolysis. These findings were recorded in a rat model and could not be confirmed in our post-aggression state patients receiving lipid doses commensurate with the usual clinical infusion rates. The serious complications that can result from hereditary fructose intolerance are completely avoidable if a careful patient history is taken before the first parenteral use of fructose. If the patient or family members and close friends, are simply asked whether he/she can tolerate fruit and sweet dishes, hereditary fructose intolerance can be ruled out beyond all reasonable doubt. Only in the extremely rare situations in which it is not possible to question either the patient or any significant other, a test dose will have to be administered to exclude fructose intolerance. The benefits of fructose-specific metabolic effects reported in the literature and corroborated by the results of out own study suggest that fructose is an important nutrient that contributes to metabolic stabilization, especially in the post-aggression phase and in septic patients. Hyperglycaemic states are largely prevented and fewer patients require ex