Der Anaesthesist
-
Continuous spinal anaesthesia (CSA) is a further means of central nerve block for anaesthesia besides single-shot spinal (SSS), combined spinal/epidural, and epidural anaesthesia. Major advantages compared to SSS are the possibility of subsequent injection of local anaesthetic via the indwelling catheter, which enables analgesia to be maintained over a longer period. Moreover, the haemodynamic effects are diminished by this mode of application. ⋯ Hence, further technical developments must have the objectives of reducing needle diameter and increasing catheter diameter. Perforation trauma to the dura is reduced by using small needles. Use of a larger catheter enables better mixing of the local anaesthetic with the CSF, and it is easier to aspirate CSF in order to establish the correct position of the catheter.
-
The introduction of electronic anaesthesia documentation systems was attempted as early as in 1979, although their efficient application has become reality only in the past few years. The advantages of the electronic protocol are apparent: Continuous high quality documentation, comparability of data due to the availability of a data bank, reduction in the workload of the anaesthetist and availability of additional data. Disadvantages of the electronic protocol have also been discussed in the literature. ⋯ There is still a lack of standards for the subsequent exchange of data and a solution to a number of ergonomic problems still remains to be found. Nevertheless, electronic anaesthesia protocols will be required in the near future. The advantages of accurate documentation and quality control in the presence of careful planning outweight cost considerations by far.
-
S-Ropivacaine is a new, long-acting amide local anaesthetic. It is the first local anaesthetic to be on the market as a single isomer. ⋯ When given epidurally, both local anaesthetics are equally effective in producing sensory block, but motor block seems to be less pronounced in the case of ropivacaine. This pharmacodynamic profile suggests that ropivacaine has a greater margin of safety and should be a valuable candidate in applications where motor blockade is to be avoided, e.g. for postoperative epidural analgesia and for epidural analgesia in obstetrics.