[Pain relief by means of continuous epidural analgesia after retroperitoneal lymph node dissection (author's transl)]. / Schmerzbekämpfung nach retroperitonealer Lymphadenektomie mit Hilfe der kontinuierlichen Epiduralanalgesie.

A retrospective study compares the effectiveness of postoperative epidural analgesia with conventional analgetic medication in cases of retroperitoneal lymph node dissection. Epidural analgesia is noted for its reduced need for additional medication and for its lower incidence of complications.

[Complications arising from catheterization of the vena cava (author's transl)]. / Komplikationen der Hohlvenenkatheterisierung.

Catheterization of the vena cava has become a routine measure in clinical practice. Its main applications are for prevention and treatment of shock, infusion therapy and parenteral feeding. Its advantages, however, are partially offset by potential complications which may arise during or after introduction of the catheter. To minimize the risk of complications the following conditions should be fulfilled: strict indication, a subtile and strictly aseptic technique and careful nursing.

[Indications and contraindications of regional anesthesia (author's transl)]. / Indikationen und Kontraindikationen der Regional-Anaesthesie.

A short introduction about common techniques of regional anesthesia and statistical data about the percentage of such procedures carried out in our institute are presented. Important techniques and aims of regional anesthesia are clearly pointed out. The results of our study are discussed in detail, as are the advantages, disadvantages, indications, and contraindications of regional anesthesia. Finally the paper concludes with our impression of regional anesthesia, its significance and status in China.

[Obstructive jaundice of benign and malignant origin: anesthesia]. / Der Verschluss-Ikterus aus benigner und maligner Ursache: Anaesthesie.

In the preparation for operation and anesthesia, as well as in the choice of drugs for premedication and actual anesthesia, the anesthesiologist should be primarily concerned about avoiding additional impairment of liver function. The result of an inquiry shows that neuroleptanalgesia is by far the most commonly used anesthetic method. In general, anesthetics that have to be detoxified in the liver microsomes are to be dispensed with. Regional anesthesia is advisable only in combination with general anesthesia. A well balanced postoperative infusion therapy is of utmost importance.

[Cutaneous cerebrospinal fluid fistula associated with secondary puncture of the dura caused by a peridural catheter]. / Cutane Liquorfistel im Anschluss an eine sekundäre Duraperforation durch einen Periduralkatheter.

Prolonged liquor fistula following puncture of the subdural space for diagnostic or anaesthetic purposes has been reported repeatedly. These among other factors are held responsible for headache as well as neurological complications in connection with lumbar puncture. In contrast the appearance of an external liquor fistula in the lumbar region is an extremely rare event. Two patients developed a cutaneous liquor fistula after lumbar laminectomy following an inadvertant dural penetration when an epidural steroid injection was performed. The same occurred in a healthy young patient who had undergone several trials to puncture the epidural space for an epidural anaesthesia in a case of emergency cesarean section Our own observation concerns a 62 years old woman who developed a cutaneous cerebrospinal fluid fistula 12 h after the removal of an epidural catheter, which had caused a secondary perforation of the dura.

[Anesthesia during extracorporeal shock wave lithotripsy]. / Die Anästhesie bei extrakorporaler Stosswellenlithotripsie (ESWL).

Three important anaesthesiological methods are considered to be appropriate in anaesthetizing patients undergoing extracorporal shock wave lithotripsy: general anaesthesia, epidural anaesthesia and recently opioid analgesia. In 161 patients who underwent ESWL in epidural anaesthesia, the dosage of the local anaesthetic (bupivacaine 0.5% without adrenaline) was dependent on the level of insertion of the Tuohy-needle and on the age of the patients. Under a sufficient therapy with crystalloids and colloids, cardiovascular parameters such as blood pressure and heart rate remained remarkably stable. In 10 patients the influence of epidural anaesthesia during ESWL on the glomerular filtration rate (GFR) was investigated. After the injection of radio-labelled 51-Cr-EDTA the GFR was significantly reduced by the epidural block. Under the influence of extracorporal shock waves the GFR increased significantly and in some cases exceeded the original value. Opioid analgesia with alfentanil in awake, spontaneously breathing patients is well accepted by patients with kidney stone disease who have to undergo ESWL. The analgesia is achieved by administering an initial bolus injection (30 micrograms/kg) of alfentanil and applying additional injections--each 15 micrograms/kg--on demand. A study with 360 patients was performed in order to investigate the suitability of opioid analgesia during ESWL with special regard to cardiovascular and respiratory depression and other side-effects. Mean systolic and diastolic blood pressure and heart rate were almost not affected. Under insufflation of oxygen by a nasal tube, the mean PaCO2 always showed normal values. Mean PaCO2 increased to 50 mm Hg. A mild drowsiness could be observed in all patients. Two of them developed a complete respiratory arrest accompanied by a muscular rigidity of the chest wall so that respiratory support by mask ventilation became necessary. The "extracorporal piezoelectric lithotripsy" (EPL) is a new method of non-invasive disintegration of kidney stones and can be performed in the non-anaesthetized patient. The efficacy of this much more profitable procedure is equivalent to the ESWL, so that the EPL seems to have a great future.

[Initial experiences with propofol (Disoprivan) for anesthesia induction in pediatric anesthesia]. / Erste Erfahrungen mit Propofol (Disoprivan) zur Narkoseeinleitung in der Kinderanaesthesie.

Propofol is a new intravenous anesthetic agent that provides smooth and rapid induction of anesthesia. A short elimination half-life guarantees rapid recovery. Since it has been reformulated as an emulsion in soya bean oil, anaphylactoid reactions are unlikely to occur. As compared to adults, there is very little experience with propofol in pediatric anesthesia. The aim of this study was to evaluate propofol as an induction agent in children with respect to cardiovascular and respiratory effects and to investigate the incidence of other side-effects. METHOD. In 25 ASA I children aged 3-12 years (6.4 +/- 2.7 SD) anesthesia was induced with a single dose of propofol, after standard premedication with atropine 0.01 mg/kg and Thalamonal 0.04 ml/kg. Anesthesia was maintained with halothane, nitrous oxide, and oxygen. Blood pressure (BP), heart rate (HR), and arterial oxygen saturation (SaO2) were measured before and each minute for 6 min after propofol administration. The incidence of side-effects during induction of anesthesia as well as during recovery and the postoperative period were recorded. RESULTS. Propofol 2.5 mg/kg produced rapid and smooth induction of anesthesia. Mean arterial pressure decreased after 1 min by 14.3% with a maximum of 16.8% after 3 min. HR was influenced differently by propofol; children with initially high HR had a decrease in HR, whereas in children with a low initial rate, HR increased transiently. After 1 min, no further changes occurred. Although no apnea was observed, respiration was shallow and depressed, as indicated by a decrease in SaO2. Two children complained of pain and 4 of discomfort at the site of the injection; 1 of these developed transient phlebitis.(ABSTRACT TRUNCATED AT 250 WORDS)

The volatile anesthetics, halothane, enflurane and isoflurane, influence the distribution of thiopental in man differently.

In man, a change of thiopental pharmacokinetics was observed under halothane anesthesia, but not when patients were anesthetized with enflurane and isoflurane. After an initial subanesthetic dose of 50 mg thiopental, the concentrations in serum (T) were determined over 15 min (4 samples). From these T-values the pharmacokinetic parameters Vc (central volume of distribution), t1/2 alpha and Cl were established (control). 16 min after the first thiopental dose, one of the inhalation anesthetics was administered (randomized). After 45 min exposure to the respective inhalation anesthetic (2-3 MAC in combination with N2O, steady-state a second dose of 50 mg thiopental was injected and the T-values were determined again over 15 min. The T-values of the control course varied considerably; the logarithmic frequency distribution revealed two distinct subgroups of patients, A and B, with characteristic Vc and t1/2 alpha. Both subgroups were influenced by the volatile anesthetics in a similar way with regard to pharmacokinetic parameters. With halothane, Vc was decreased and t1/2 alpha was shortened. In contrast, enflurane and isoflurane did not affect the pharmacokinetic parameters.

[Vecuronium in infants and children: clinical and neuromuscular effects]. / Vecuronium bei Säuglingen und Kleinkindern: klinische und neuromuskuläre Effekte.

The neuromuscular and cardiovascular effects of vecuronium (Norcuron, Organon Teknika) were studied in 58 infants (1 day-10 months) and 65 children (1-6 years) anaesthetized either with halothane or under balanced anaesthesia. After a bolus dose of 70 micrograms/kg vecuronium the time course of neuromuscular blockade was determined using an electromyographic equipment. Onset time (time to maximal effect) was significantly shorter in infants compared with children; 1.4 +/- 0.7 min (min +/- SD) and 2.7 +/- 0.8 min, respectively. In contrast the recovery index (time for 25% to 75% recovery) was longer in infants than in children 18 +/- 6.7 min and 10 +/- 2.3 min, respectively. Repetitive administration of vecuronium, up to five maintenance doses, did not show any cumulative effects in children under balanced anaesthesia. After repetitive administration the recovery index was 12 +/- 1.7 min. Vecuronium (a bolus dose of 80 or 100 micrograms/kg) did not cause any significant change of blood pressure in infants and children anaesthetized either with halothane or by balanced anaesthesia. Infants under balanced anaesthesia showed a significant decrease in heart rate 15 min after administration of vecuronium. In contrast an increase in heart rate could be observed in children under halothane anesthesia, which was not attributed to vecuronium.

[A clinical study on the use of etomidate for induction and maintenance of anaesthesia (author's transl)]. / Klinische Erfahrungen mit Etomidate zur Narkoseeinleitung und -unterhaltung.

The action of etomidate, a short-acting non-barbiturate hypnotic agent, was studied in three groups of patients. Used alone for induction it did not significantly alter either the pulse rate or the diastolic blood pressure. Systolic blood pressure fell slightly, but became stable after 2 minutes. The pH of the arterial blood was not significantly altered. pO2 and pCO2 showed changes indicative of respiratory depression during induction (group 1). Etomidate combined with fentanyl caused a moderate, significant fall in both diastolic and systolic blood pressure, but did not affect the pulse rate (group 2). In view of its inconsiderable haemodynamic effects etomidate can be regarded as a safe agent for induction. In doses of 10-20 micrograms/kilogramme bodyweight/minute infusions of etomidate (combined with fentanyl and muscle relaxants) provide adequate basal narcosis for most routine surgical operations. It cannot, however, be considered the anaesthetic of choice for major abdominal surgery which requires deep analgesia and full muscular relaxation (group 3).

Side effects and changes in pulmonary function after fixed dose precurarization with alcuronium, pancuronium or vecuronium.

On hundred and sixty premedicated patients undergoing surgery were assessed for changes in pulmonary function and signs of partial neuromuscular blockade following precurarization with a fixed dose of alcuronium 2 mg, pancuronium 1 mg or vecuronium 1 mg, and the efficacy of the drugs in the prevention of suxamethonium-associated side effects was compared. In this respect, no differences were observed between the three drugs. Pretreatment with alcuronium and pancuronium was followed by small decreases in pulmonary function. Statistically significant changes were seen only when vecuronium 1 mg was used as the fixed-dose precurarization agent.