Der Anaesthesist
-
The routine administration of supplemental oxygen to women undergoing elective caesarean section under regional anesthesia in order to optimize oxygen supply to the fetus is common anesthetic practice in many German hospitals. However, this practice has been controversially discussed in the non-German literature for many years. This review presents and discusses the pros and cons of routinely providing supplemental oxygen to a parturient during caesarean section on the basis of the literature published over the last 30 years. ⋯ Opponents of routine oxygen supplementation allude above all to an increase in free radical activity in both mother and fetus; however, data in this respect are not consistent either. As supplemental oxygen to patients undergoing elective caesarean section without any risk factors under regional anesthesia is associated with potential risks while no advantage has so far been demonstrated, routine administration of oxygen has to be challenged and is no longer considered to be indicated by many. On the contrary, in cases of emergency with a concomitant risk of hypoxia for mother and fetus, administration of oxygen is indispensable in the light of present data.
-
Regional anesthesia is the most effective procedure for acute pain therapy. Whether neuraxial and peripheral blocks in patients with pre-existing infectious conditions, immune deficits or other risk factors increase the risk of additional infections is unclear. ⋯ A strict contraindication in patients with pre-existing systemic or local infections seems unjustifiable. A clear and documented risk-benefit ratio in these patients is mandatory.
-
Randomized Controlled Trial Comparative Study
[Distal sciatic nerve blocks: randomized comparison of nerve stimulation and ultrasound guided intraepineural block].
The design of this study is related to an important current issue: should local anesthetics be intentionally injected into peripheral nerves? Answering this question is not possible without better knowledge regarding classical methods of nerve localization (e.g. cause of paresthesias and nerve stimulation technique). Have intraneural injections ever been avoided? This prospective, randomized comparison of distal sciatic nerve block with ultrasound guidance tested the hypothesis that intraneural injection of local anesthetics using the nerve stimulation technique is common and associated with a higher success rate. ⋯ For distal sciatic nerve blocks using the nerve stimulation technique, intraepineural injection of local anesthetics is common and associated with significant and clinically important higher success rates as well as shorter times until readiness for surgery. In both groups no block-related nerve damage was observed. The results indicate that for some blocks (e.g. sciatic, supraclavicular) perforation of the outer layers of connective tissue was always an important prerequisite for success using classical methods of nerve localization (cause of paresthesias and nerve stimulation technique). Additional nerve stimulation with an ultrasound-guided distal sciatic nerve block cannot make any additional contribution to the safety or success of the block. New insights concerning the architecture of the sciatic nerve are discussed and associated implications for the performance of distal ultrasound-guided sciatic nerve block are addressed.
-
A 76-year-old patient developed necrosis of the index finger after placement of a radial artery catheter. This article discusses the risks associated with invasive blood pressure monitoring and treatment options in cases of critical ischemia. The authors conclude that there is no consensus concerning optimal treatment and that a discussion on options for preoperative risk assessment and quickest possible recognition of such complications is worthwhile. Despite the risk of ischemia invasive blood pressure monitoring is an indispensable procedure.
-
Case Reports
[Faulty internal tube in a co-axial ventilation tube system: cause of a massive postoperative hypercapnia].
This article presents the case of a patient with massive postoperative hypercapnia during mechanical ventilation in the intensive care unit (ICU). With normal tidal volumes and clearly visible chest movements, adequate findings with regard to auscultation, oxygenation and correct respirator settings, no cause for the increasing hypercapnia was initially found; however, replacement of the respirator led to a return to normal carbon dioxide levels. When checking the replaced respirator a service technician found the cause of the respirator failure: the internal tube of the co-axial ventilation system was faulty leading to an increased dead space and rebreathing of carbon dioxide.