Anaesthesia for ear surgery in remote or resource-constrained environments.

BACKGROUND: The successful provision of middle-ear surgery requires appropriate anaesthesia. This may take the form of local or general anaesthesia; both methods have their advantages and disadvantages. Local anaesthesia is simple to administer and does not require the additional personnel required for general anaesthesia. In the low-resource setting, it can provide a very safe and effective means of allowing middle-ear surgery to be successfully completed. However, some middle-ear surgery is too complex to consider performing under local anaesthesia and here general anaesthesia will be required. CONCLUSION: This article highlights considerations for performing middle-ear surgery in a safe manner when the available resources may be more limited than those expected in high-income settings. There are situations where local anaesthesia with sedation may prove a useful compromise of the two techniques.

Consideraciones básicas para el manejo del dolor en odontopediatría en la práctica diaria del cirujano dentista general y su relación de interconsulta con el anestesiólogo / Basic considerations for the management of pain in dentistry in the daily practice of the surgeon general dentist and their relationship with the anesthesiologist

El dolor es un fenómeno complejo y multidimensional mediado por procesos psicoquímicos en el sistema nervioso periférico y central, cuya percepción puede modificarse considerablemente a través de una serie de mecanismos que incluyen, entre otros, fármacos, estímulos ambientales, procesos cognoscitivos y emocionales, así como condiciones sociales y culturales. La gran parte de los agentes farmacológicos que se utiliza en odontología tiene por objeto controlar la angustia y el dolor. En términos generales, la eliminación de la sensación de dolor en el ámbito dental requiere el bloqueo de la percepción del dolor por vía periférica, mediante anestesia local o por vía central, con anestesia general (AU)

Pain is a complex and multidimensional event regulated by psycho-chemical processes in the peripheral and central nervous system; pain perception can be modified by different mechanisms that include, between others, drugs, environmental stimuli, cognoscitive and emotional processes, and cultural and social conditions. The drugs that are used in odontology try to control the pain. In general, it is necessary to stop the peripheral and central pain perception using local or general anesthesia, respectively (AU)

[New approaches for determination of area of superficial functional and anatomic objects in pediatric anesthesiology and surgery].

A hypothesis concerning expediency for application of a Bezye's curves in anesthesiology while solving the tasks of the images recognition of a functional part hyperalgesia and hemangioma.

[Diagnostic and therapeutic instruments for the pain clinic: introduction].

Pain, a very unpleasant feeling often difficult to treat, is the most common complaint of patients visiting hospital. When a patient with pain visits our institution, first of all, we have to diagnose the pain including the grade of pain and stress associated with sympathetic-adrenal-medullary system. We then treat the pain of the patient using available devices. In the following special articles, functional magnetic imaging, device for measurement of salivary alpha-amylase and PainVisionTM for pain measurement are described as devices for diagnosis of pain. As devices for treatment of pain, epidural infuser pump, intrathecal infusion pump, spinal cord stimulation device and phototherapy device are also described. The mechanism and grade of intractable pain often confuse us to recognize pain. The devices, described in this special issue, are very useful for the evaluation and treatment of intractable pain. I feel happy if these articles greatly contribute to the treatment of patients with pain by pain clinicians.

Vagal nerve stimulation: overview and implications for anesthesiologists.

Vagal nerve stimulation is an important adjunctive therapy for medically refractory epilepsy and major depression. Additionally, it may prove effective in treating obesity, Alzheimer's disease, and some neuropsychiatic disorders. As the number of approved indications increases, more patients are becoming eligible for surgical placement of a commercial vagal nerve stimulator (VNS). Initial VNS placement typically requires general anesthesia, and patients with previously implanted devices may present for other surgical procedures requiring anesthetic management. In this review, we will focus on the indications for vagal nerve stimulation (both approved and experimental), proposed therapeutic mechanisms for vagal nerve stimulation, and potential perioperative complications during initial VNS placement. Anesthetic considerations during initial device placement, as well as anesthetic management issues for patients with a preexisting VNS, are reviewed.

The use of general anesthesia to facilitate dental treatment.

General anesthesia can help the dental professional provide treatment to individuals who otherwise would be unable to receive dental care. State-mandated training, current anesthesia techniques, and adequate planning by the dentist make general anesthesia safe and effective in the private dental office. This article discusses the multiple benefits general anesthesia offers both the dentist and the patient. Suggestions are presented to facilitate the accessibility and utilization of general anesthesia for routine office dental care.

[Robert R. Macintosh and Spain: a productive relationship]. / Robert R. Macintosh y España: una relación fecunda.

Through his visit to Spain in 1946, Robert R. Macintosh exercised considerable influence on the introduction and development of modern anesthesia in this country. This paper reviews the technical advances Mackintosh introduced and considers how his visit was one of the most important factors in unleashing the development of the profession here. Also reviewed are the other visits Mackintosh made in the course of his career. Those trips were less important, with the exception of a 1937 visit that inspired the design of the Oxford vaporizer, a technical concept based on simplicity, safety and the anesthesiologist's experience.

History of anesthesia in Germany.

The first ether anesthetic was administered in Germany by J.F. Heyfelder (1798-1869) at the Erlangen University Hospital on January 24, 1847. Thereafter, famous discoveries occurred in the field of pharmacology. Albert Niemann isolated cocaine from the coca shrub in 1860; Emil Fischer synthesized the first barbiturate, Veronal, in 1902; and Helmut Weese promoted the first ultra-short-acting barbiturate, hexobarbital (Evipan), in 1932. The local anesthetic effect of cocaine was reported by Koller at the Congress of the German Society for Ophthalmology on September 15, 1884, in Heidelberg. Many new techniques were tried first in German hospitals. Friedrich Trendelenburg carried out, by tracheotomy, the first operation with endotracheal intubation in 1869, and Franz Kuhn promoted and clinically practiced endotracheal intubation in Heidelberg beginning in 1900. August Bier performed the first operation under spinal anesthesia at the Kiel University Hospital on August 16, 1898. Carl Ludwig Schleich (1859-1922) standardized the methods of infiltration anesthesia by using a cocaine solution in sufficient dilution. The development of anesthesia machines was greatly influenced by Heinrich Dräger (1847-1917) and his son Bernhard Dräger (1870-1928). The Dräger Company in Lübeck built the first anesthesia machine with a carbon dioxide (CO2) absorber and circle system in 1925. Paul Sudeck and Helmut Schmidt worked with this system at the Hamburg University Hospital and reported their results in 1926. The first Dräger anesthesia machine was produced in 1902 and introduced into clinical use by Otto Roth (1863-1944) in Lübeck. Before the Second World War, three universities in Germany carried out research in the field of anesthesia: the University of Freiburg with H. Killian, the University of Hamburg with P. Sudeck and H. Schmidt, and the University of Würzburg with C.G. Gauss. Killian and Gauss established the first journals, Der Schmerz and Narkose und Anaesthesie, in 1928. After the Second World War, the field of anesthesia in Germany rapidly regained international standards. The journal Der Anaesthesist was founded in 1952, and the German Society for Anesthesiology and Intensive Medicine was established in 1953.

Outpatient anesthesia.

More complex methods of outpatient anesthesia, including I.V. sedation and general anesthesia, have become commonplace. Patient selection and preoperative evaluation are discussed, as well as the choice of who will deliver anesthesia. Appropriate outpatient facilities and monitoring are reviewed. The authors' favorite methods of anesthesia, caveats, and suggestions are presented, as well as prevention and treatment of anesthesia problems and emergencies.

[High continuous axillary-brachial plexus anesthesia. Comparison of a new method with perivascular axillary-brachial plexus anesthesia]. / Die hohe kontinuierliche axilläre Plexus-brachialis-Anaesthesie. Vergleich einer neuen Methode mit der perivaskulären axillären Plexus-brachialis-Anaesthesie.

High axillary brachial plexus anaesthesia was performed in 25 patients. This technique employs simple, straight forward axillary access, and produces an infraclavicular brachial plexus block which is adequate for anaesthesia of the entire arm. The technique and the equipment required are described in the text and illustrated by the figures. Twenty patients who received high axillary brachial plexus anaesthesia were compared with 20 patients who received conventional axillary brachial plexus anaesthesia. The arm anaesthesia attained was classified as being of the analgesic or the anaesthetic stage by pin-prick testing at 4-min intervals, and the motor block, as paretic or the paralytic stage. Five incorrect catheter placements (i.e., 20%) were observed in the group with high axillary brachial plexus anaesthesia; however, they could be revised to produce conventional axillary brachial plexus blocks. Blood mepivacaine level determinations performed over a 90-min period showed that the relatively high dosage used (with average 7.29 gm/kg body weight) did not result in toxic blood levels. This technique involves advancing the catheter 8.3-20 cm (mean 13.9 cm) beyond the puncture site. In 11 cases, it was necessary to overcome resistance when advancing the needle. The site of placement was determined by electrostimulation and cold-temperature-testing. Comparison of both groups revealed that the block is faster and more complete, and the nerves which are usually difficult to block with plexus anaesthesia are anaesthetized better with the high axillary block than with the conventional technique. The anaesthesia of the axillary and musculocutaneous nerves showed an impressive improvement. Whereas the usually difficult block of the radial nerve in the hand was greatly improved, the median and ulnar nerves were blocked equally well using either method. The only complication that occurred was an intravenous catheter placement, which was diagnosed and corrected. No other early or late complications were observed following the use of this technique in a large group of patients. This new technique is simple and easy to master.