Praktische Anästhesie, Wiederbelebung und Intensivtherapie
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Clinical Trial Controlled Clinical Trial
[The influence of sedation with diazepam and flunitrazepam during regional anaesthesia upon postoperative pulmonary performance (author's transl)].
In 32 patients between 53 and 86 years of age, undergoing transurethral prostatectomy, the influence of intraoperative sedation with Diazepam (5-10 mg) and Flunitrazepam (0,4-0,8 mg) on postoperative forced vital capacity, forced exspiratory volume (1 sec.) and peakflow, were measured, compared to placebo. We could not find a depression of these ventilatory parameters, in the three groups except peak-flow after sedation with Flunitrazepam in the evening after operation (p less than or equal to 0,05). We conclude that sedation during regional anesthesia does not impair the most important advantage of local anesthesia, the minor effect on ventilation, compared with general anesthesia.
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A technique for continuous block of the brachial plexus is described using an indwelling teflon cannula positioned according to the anatomical dictates of the supraclavicular and interscalene spaces. The anatomy is presented as key to consistent results. Advantages of a continuous block are an extension of normal block duration, block placement independent of operating times and a possible application to intensive care patients.
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The decision regarding fitness of a person to undergo surgery and anaesthesia is made by the surgeon and anaesthetist according to agreed criteria. The physician takes part in the decision only in those cases where additional information regarding the type and extent of the disorder is required or when doubtful findings need further clarification. Closer co-operation between anaesthetist and physician regarding the indications for pre-operative tests and investigations is desirable.
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The risks attendant on regional anaesthesia derive from the condition of the patient, the technique employed and the skill, or lack of skill, on the part of the anaesthetist. Patient-determined risk factors are: existent diseases and pathological conditions which in many cases cannot be rectified pre-operatively. ⋯ Each technique carries its own specific risk. With due care many of the complications can be prevented.
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Controlled respiration should have a place not only in cases of hypoventilation but also in the treatment of comatose and hyperventilating persons. Hyperventilation is liable severely to interfere with the blood supply to the brain, and this disturbance, in conjunction with the primary disease responsible for the comatose condition, such as hyperglycaemia, diabetes or cerebral trauma, may be a contributing factor to the lethal outcome. Controlled respiration helps towards regulation of the cerebral circulation and of the acid-base balance and provides improved conditions for normalization of the disturbed metabolism and thus greatly improves the prognosis of these cases.