Der Anaesthesist
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It may be presumed that in 1979, 150 maternal deaths will occur in obstetrics (0.27 per 1000) in the Fed. Rep. of Germany, 40% of which will be due to caesarean sections. From 30% to 50% of this maternal death rate, must be related in one or another aspect to general or local anaesthesia. ⋯ Anaesthesists as well as obstetricians should be aware of the increased maternal risk from general or local anaesthesia. The maternal risk should be minimized. This can either be achieved if experienced anaesthesists only are responsible for obstetric anaesthesia (general as well as epidural, spinal etc.) if anaesthesia (general as well as local) is not considered as a comfortable service only but a strictly indicated medical procedure, and if new methods are developed to overcome the particular maternal risk in some regard.
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Recent progress in narcotic drug research is briefly reviewed. Several investigators were able, independently to identify stereospecific opiate receptors, which mediate the specific effects of narcotic analgesics. ⋯ The chemical structure of some of these endorphines could be analyzed. Endorphines are suggested to be involved in pain perception, electroanalgesia, acupuncture analgesia, psychiatric disorders, synthesis and release of pituitary hormones.
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As part of an agreement between the Governments of the People's Republic of China and Canada, 10 Canadian Anaesthetists visited China for six weeks during April and May 1974. The delegation observed 87 surgical operations and 19 dental procedures conducted under acupuncture analgesia in 17 large hospital in Peking, Schichiachuang, Nanking, Shanghai and Canton. In this report, observations on acupuncture analgesia made during this visit are presented as well as information obtained in group discussions with Chinese physicians. ⋯ Acupuncture analgesia poses considerable limitations on the surgeon and requires careful surgical technique; the patient's co-operation must be assured by a suitable preparation. It appears, that acupuncture analgesia should be seen as an alternative to local anaesthesia rather than general anaesthesia; the latter is only used to a limited extent in China. In our present anaesthetic practice, acupuncture would appear to be of only very limited use, however, a further study of this phenomenon should contribute to our knowledge of the function of the nervous system.