Regional-Anaesthesie
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Regional-Anaesthesie · Jan 1990
[Elimination of the obturator reflex as a specific indication for dilute solutions of etidocaine. A study of the suitability of a local anesthetic for reflex elimination in the 3-in-1 block technic].
Direct stimulation of the obturator nerve by the electroresectoscope during transurethral resection of tumors in lateral bladder regions is possible under regional or general anaesthesia without muscle relaxation. The resulting obturator reflex may lead to perforation of the bladder. Two different regional techniques can be used to interrupt the obturator reflex arc: (1) separate block of the obturator nerve; or (2) the "3-in-1 block" (Winnie). ⋯ Elimination of the obturator reflex is the only specific motor nerve block in anesthesia. Diluted etidocaine solutions seem to be adequate: irrespective the technique used for eliminating the reflex, diluted etidocaine produces a good effect and permits a dosage reduction compared with other local anesthetics. It is possible to block the obturator nerve bilaterally by "3-in-1 block" or unilaterally by "3-in-1 block" in combination with epidural analgesia within the recommended dose limits.
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Regional-Anaesthesie · Nov 1989
Review[Hemostatic requirements for the performance of regional anesthesia. Workshop on hemostatic problems in regional anesthesia].
There is uncertainty as to which preoperative examinations are necessary before performing regional anesthesia. Therefore an interdisciplinary consensus conference was established to obtain recommendations on some of the open questions related to this topic. Preoperative laboratory examinations are not necessary prior to peripheral nerve blocks near large vessels if these are easy to compress. ⋯ If plasma expanders are administered perioperatively, the highest bleeding risk exists after dextran infusions. There is also an increased bleeding risk if nonsteroidal anti-inflammatory drugs, especially acetylsalicylic acid, are administered repeatedly within 5 days prior to spinal/epidural anesthesia. In these patients preoperative determination of the clotting time appears necessary.(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional-Anaesthesie · Sep 1989
Comparative Study[Mother and child stress parameters during cesarean section with general and peridural anesthesia].
This study compared maternal and fetal stress responses during cesarean section in either general anesthesia (GA) or epidural anesthesia (EA). Ten patients received GA with thiopental induction, intubation, and controlled ventilation with nitrous oxide and oxygen. After delivery, anesthesia was supplemented with fentanyl 0.2-0.3 mg. ⋯ Maternal epinephrine levels were lower under EA and below the normal range (EA 23 pg/ml, GA 77 pg/ml, P = 0.002); levels increased during GA and decreased during EA (P = 0.01). No statistical differences were seen in maternal norepinephrine (EA 206 pg/ml, GA 354 pg/ml). MAP was lower during EA (group levels EA 81 mmHg, GA 95 mmHg, P = 0.0002) and HR was higher during GA (group levels EA 89/min, GA 104/min, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Regional-Anaesthesie · Sep 1989
Case Reports[Subdural location of a catheter. A complication of peridural anesthesia].
A case of an involuntarily placed subdural catheter (between arachnoid and dura) is described. The catheter was thought to be in the epidural space. It was placed at T9/10 in order to achieve postoperative epidural analgesia in a patient with colonic surgery. ⋯ In addition, the symptoms of 'subdural analgesia' vary to a great extent. Therefore, the diagnosis can only be verified by X-ray examination. If patients with epidural analgesia are supervised with care and uncommon dose responses are recognized, subdural catheter placement will not lead to a severe and dangerous situation for the patient.
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Regional-Anaesthesie · Jul 1989
[Initial experiences with a novel nerve stimulator for use in axillary plexus anesthesia].
The advantages of an electrical nerve stimulator for detection of the axillary neurovascular sheath have been frequently described in the literature and are now well known. In most of these techniques, stimulation is achieved by a fixed electrical voltage and variable amplification. The new nerve stimulator presented here offers the possibility of measuring the current at the site of stimulation ("test" position). ⋯ Thus, disturbances in the circuit between nerve stimulator and patient, as shown in the two cases, can be detected. According to our experience, the intensity of stimulation for successful nerve blockade should be approximately 0.5 mA or lower. Consequently, universally applicable stimulating instruments with constant electrical tension should allow fine tuning of the current in 0.1-mA aliquots.