Langenbecks Archiv für Chirurgie
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Experiences and results of 7212 brachial plexus blocks by the supraclavicular and 404 by the axillary approach are reported. The times of onset and duration of several local anesthetics are compared. The incidence of pneumothorax was 0.42% (30 cases) when the supraclavicular approach was used. Therefore the axillary technique is recommended to avoid this serious complication.
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Langenbecks Arch Chir · Nov 1977
[New aspects of field blocks and peripheral nerve blocks (author's transl)].
There have been no new developments concerning field blocks. The need for limiting the dosage of local anesthetic agents is stressed. Two methods for perivascular block are described and the use of CO2 containing local anesthetic solutions is discussed as well as the employment of peripheral nerve stimulators.
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Langenbecks Arch Chir · Nov 1977
[Regional anesthesia today--possibilities and limits: introduction (author's transl)].
The various procedures of regional anesthesia were widely used before the introduction of intratracheal anesthesia; thereafter, it was replaced by the today commonly used general anesthesia. Regional anesthesia nonetheless plays an important role, primarily in outpatient treatment, because a large number of surgical departments still have no anesthesiologist on the staff. Often the surgeon is responsible for both the operation and the anesthesia. Indications, risks, and complications including legal problems related to regional anesthesia are discussed.
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Because of our own experiences with more than 10,000 cases of spinal anesthesia without neurologic complications, it is emphasized that the method has regained clinical importance due to modernized techniques, new local anesthetics (lidocain, mepivacain, bupivacain), and a better understanding of the pathomechanisms involved. Restricting the spinal block to the D 8 dermatome level, thus avoiding side effects, and sticking to a clear-cut range of contraindications renders spinal anesthesia a method that compares favorably with that of general anesthesia in the high-risk patient.
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Langenbecks Arch Chir · Nov 1977
[Interdisciplinary limits of jurisdiction and responsibility from a legal viewpoint (author's transl)].
In the interdisciplinary cooperation between the surgeon and the anesthetist, the following factors are in effect: the principle of strict division of labor; each brings the functions of his specialty and carries complete responsibility for them; the principle of trust: each can depend on the meticulousness of the other, as long as no obvious qualification deficiencies are apparent; obligation for coordination: each must accommodate himself to the requirements of the other specialty.