Der Anaesthesist
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Review
[Ultrasound in local anaesthesia. Part II: ultrasound-guided blockade of peripheral nerve channels].
Recent developments in blockade techniques are based on the possibilities offered by modern sonography. With high frequency linear probes, the smallest tissue structures, such as peripheral nerves, in areas close to the surface can be visualised. ⋯ Apart from these, one particularly important aspect is that they reduce the risks of local anaesthesia procedures by direct imaging of neighbouring anatomical structures. In this article the theoretical basis of ultrasound techniques and their practical use in local anaesthesia will be presented.
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Molecular biological investigations led to the discovery of the ORL1 receptor ( opioid receptor like-1 receptor) and its endogenous ligand nociceptin. Although its sequence and structure are closely related to traditional opioid receptors, the ORL1 receptor shows low binding affinities for selective opioid agonists and antagonists. On the other hand, the ORL1 ligand nociceptin does not bind to the three traditional opioid receptors. ⋯ The physiological role and detailed mechanisms of these dose-dependent nociceptin effects in opposite directions are not yet known. In addition, nociceptin modulates other biological phenomena such as feeding, locomotion, gastrointestinal function,memory, cardiovascular function,immunity, renal function, anxiety,dependence and tolerance. Future research on the physiological and pathophysiological importance of the nociceptin/ORL1 receptor systems may provide a target for novel therapeutics.
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Case Reports Comparative Study
[Cesarian section and local anaesthesia: insufficient spread of spinal anaesthesia with hyperbaric bupivacaine 0.5%/5% glucose compared to hyperbaric bupivacaine 0.5%/8% glucose?].
In our hospital hyperbaric Carbostesin 0.5% (AstraZeneca) had been substituted by hyperbaric Bucain 0.5% (Curasan) and both drugs were believed to be identical in their actions. However, both local anaesthetics differ in the amount of glucose they contain. ⋯ The third patient received the normally used combination of hyperbaric Carbostesin 0.5% and fentanyl and the subarachnoid block proceeded completely uneventfully. According to the literature the clinical efficacy of hyperbaric Carbostesin 0.5% and hyperbaric Bucain 0.5% should be identical and therefore a critical dilution of the Bucain should not have occurred because of the addition of fentanyl.