Der Anaesthesist
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We report the case of a 4 year old boy who developed a massive water intoxication as a complication during knee arthroscopy. The sodium plasma concentration dropped to 100 mmol/l postoperatively. ⋯ The guidelines for replacing sodium in hyponatremia are discussed according to literature. In general, hyponatremia should be corrected in the same amount of time as it took for it to develop.
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Case Reports
[Epileptoform EEG activity: occurrence under sevoflurane and not during propofol application].
In a 62-year-old female patient without a history of epileptic seizures EEG monitoring (EEG monitor: Narcotrend) was routinely performed during propofol/remifentanil and during sevoflurane/remifentanil/nitrous oxide anaesthesia. In the first course of anaesthesia after a bolus of propofol 1% a continuous EEG slowing was followed by a burst suppression pattern without occurrence of epileptiform activity throughout this sequence. During the second course of anaesthesia the sevoflurane concentration was increased from 2 to 8 % by volume. After 5 min epileptiform activity appeared in the EEG at an endtidal concentration of 5.9% by volume.
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Clinical Trial
[Danaparoid (Orgaran) as an antiocoagulant for mechanical autotransfusion with Cell Saver 5 (Hemonetics)].
We investigated Danaparoid Sodium (Orgaran) as anticoagulant using three different concentrations (9, 4,5 or 3 U/ml anticoagulant solution) for the use in the autotransfusion device Cell Saver 5 (Haemonetics). Fresh units of whole blood packs were mixed in the reservoir in a proportion of 5:1 with the anticoagulant solution. Having started the Cell Saver 5 in the automatic mode, the amount of Danaparoid in the retransfusion blood was determined (chromogenic Antifactor-Xa test). ⋯ One of them had slight clotting in the reservoir. We recommend the use of the lower concentrations tested: 4,5 U/ml or, particularly for patients with renal insufficiency or low body weight or expected high retransfusion volumes, 3 U/ml as anticoagulant concentrations. If the autotransfusion device is used according to the manufacturer's instructions there may be virtually no risk of clotting in the Cell Saver or of inhibition of the coagulation system in the patient.