Der Anaesthesist
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Myasthenia gravis is a chronic autoimmune disease characterised by progressive weakness and easy fatigability of voluntary skeletal muscles. These symptoms are related to a decrease in the number of functional acetylcholine receptors, impaired neuromuscular transmission, and a broadened neuromuscular cleft. Symptomatic treatment is based on anticholinesterases in order to increase the synaptic dwell of acetylcholine. ⋯ Although sensitivity to non-depolarising neuromuscular blocking agents is increased, muscle relaxants can be administered during general anaesthesia as long as neuromuscular monitoring assesses their individual effect. Due to the individual variability in the response to muscle relaxants, accurate titration in combination with pre- and intraoperative neuromuscular monitoring is essential for myasthenic patients. Postoperatively, intensive care observation is mandatory including neuromuscular monitoring.
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Case Reports
[Exertion-related heat stroke. Lethal multiorgan failure from accidental hyperthermia in a 23 year old athlete].
We report the case of a 23-year-old rower who suffered from an exertional heatstroke while trying to lose 2 kg in weight by jogging before a competition. The development of this illness was favoured by clothes that were inappropriate for the environmental conditions and which the sportsman wore intentionally to enhance sweating. The maximum core temperature was over 43 degrees C. ⋯ In spite of maximum intensive care with an extensive substitution of blood products, continuous hemodiafiltration, and inhalative administration of nitrous oxide the young sportsman died 48 h after his admission to the intensive care unit. This tragic course demonstrates the danger of the widespread habit of losing weight by vigorously exercising with inappropriate clothes. In this article, potential risk factors, symptomatology, therapy, and methods of preventing an exertional heatstroke are shown and discussed.
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In the present study 48 sagittal and transversal magnetic resonance images of volunteers were examined for biometric data concerning risk of pneumothorax at the vertical infraclavicular blockade (VIP) of the brachial plexus. With a correct puncture the plexus can be reached after 3 cm. The shortest way to the lung is 5.3 cm (3.1-8.7 cm) at a incorrect medial angle of puncture of 46.3 degrees (35-58 degrees). ⋯ In one case, the risk for pneumothorax could be measured even with the correct puncture technique. Overall, the VIP is a very safe method for brachial plexus anaesthesia with regard to the risk of pneumothorax. In asthenic women, the risk seems to be higher but can be minimised by reducing the maximum puncture depth.