Thiopentone, thiopentone/ketamine, and ketamine for induction of anaesthesia in caesarean section.

Seventy-five healthy patients were randomly allocated to receive thiopentone, thiopentone/ketamine or ketamine for induction of anaesthesia for elective Caesarean section. Thiopentone resulted in the most pronounced and ketamine in the smallest drop in blood pressure, while the combination induced only moderate haemodynamic changes. Intra-operative awareness occurred in one patient in the thiopentone group, six of the ketamine patients had nightmares, and one patient of the combination group reported pleasant dreams but no awareness. The muscle tone of neonates in the thiopentone group was more reduced than in neonates in the other two groups. Infants delivered after uterine incision-to-delivery intervals exceeding 3 min more often had Apgar scores < 7 than those delivered in less than 3 min.

[Anesthesiology problems in Takayasu's syndrome]. / Anaesthesiologische Probleme beim Takayasu-Syndrom.

Takayasu's disease is a rare form of nonspecific obliterative panarteritis of unknown origin, mainly located at supraaortic, renal, and pulmonary arteries and resulting in multiple stenoses and occlusion of major arteries. Predominantly young women in the first three decades of life are affected. Absence of arm pulses, vascular bruits, and retinopathy are classic symptoms. Another symptom is hypertension of the lower extremities and hypotension of the upper extremities, thus potentially impairing cerebral perfusion. A 25-year-old female patient with a 2-year history of Takayasu's disease presented for therapeutic abortion on the grounds of her medical condition. There were significant stenoses of the left common carotid artery and the internal carotid artery. The left subclavian artery was totally obliterated. The arterial blood supply to the left arm was accomplished by the left vertebral artery via a subclavian steal syndrome. Brachial and radial pulses were absent in both arms. General, spinal or epidural anesthesia can produce arterial hypotension. Blood pressure assessment at the lower extremities does not allow conclusions about perfusion of supraaortic arteries and cerebral perfusion pressure. Thus, a paracervical block was performed; sedation and analgesia were achieved with small doses of midazolam and alfentanil. We planned that if general anesthesia became necessary we would induce anesthesia with etomidate and alfentanil and maintain anesthesia by mask ventilation with nitrous oxide in oxygen and supplementary doses of alfentanil. Invasive monitoring such as arterial or Swan Ganz catheterization, was contraindicated because of the possibility that inflamed vessels would become irritated. Therefore, we only monitored ECG, blood pressure at the leg, ventilation parameters, and oxygen saturation at the ear lobe by pulse oximetry.(ABSTRACT TRUNCATED AT 250 WORDS)

[Characteristics of cardiopulmonary resuscitation in pregnant women]. / Besonderheiten der kardiopulmonalen Reanimation (CPR) bei Schwangeren.

Cardiopulmonary resuscitation (CPR) during pregnancy is a rare event, but due to the increasing number of pregnant women with significant medical disorders it will gain more importance in the near future. Effective CPR with respect to survival of mother and infant can only be accomplished under optimal conditions. We discuss important pathophysiological alterations during pregnancy and, including recommendations in the available literature, we present a standardized protocol for life support for mother and infant. The protocol depends on the progress of the pregnancy. Compared to non-pregnant patients, pregnant women must be placed in a left lateral position immediately. If possible, the decision to perform open-chest CPR has to be made within 15 min of unsuccessful closed-chest CPR. In addition, during late pregnancy there should be no delay in performing an emergency cesarean section, even during CPR.

[Vecuronium bromide and succinylcholine procedures in medial relaxation. A comparison of electromyography and clinical findings]. / Vecuroniumbromid- und Succinylcholinverfahren zur mittelangen Relaxation. Ein Vergleich anhand elektromyographischer und klinischer Befunde.

UNLABELLED: Clinical and electromyographic effects of either succinylcholine (Suc) or vecuronium bromide (VEC) were compared during induction and maintenance of neuromuscular blockade for pelvic laparoscopy. METHODS: Forty ASA class I and II patients (pat.) were studied under general anesthesia with thiopental, enflurane, and nitrous oxide. Group VEC-pat. (n = 20) received 0.015 mg/kg body wt. VEC as priming and 5 min later 0.085 mg/kg as intubation doses. Repetitive doses of 0.01 mg/kg were injected to maintain twitch depression (T1%) less than or equal to 15%. Neuromuscular block was reversed with atropine and pyridostigmine (0.01 resp. 0.1 mg/kg). In group Suc-pat. relaxation was induced with 1.5 mg/kg Suc 5 min after pretreatment with 2 mg alcuronium. Relaxation (10% less than or equal to T1% less than or equal to 15%) was prolonged using a Suc infusion. Neuromuscular blockade was assessed electromyographically (Relaxograph, Datex) using train-of-four (TOF) stimulation (2 Hz for 2 s). Intubation conditions were scored according to Fahey et al. RESULTS: Pretreatment with 0.015 mg/kg VEC compared to 2 mg alcuronium led to a more pronounced decline in T1% and TOF-ratio (P less than 0.001). The time interval between injection of the intubation dose and complete relaxation (T1% less than or equal to 5%) was shorter in group Suc- than in VEC-pat. (P less than 0.001). Suc provides better intubation conditions than VEC (P less than 0.05). Recovery from muscle relaxation was faster in Suc- than in VEC-pat. (P less than 0.001). During Suc infusion in 8 patients a phase-II block (TOF ratio less than or equal to 30%) was observed. DISCUSSION: Postoperative problems are often related to an unrecognized after effects of relaxants. Suc infusion leads to a remarkable number of phase-II blocks, whereas VEC can be antagonized promptly.

[Relaxometry with the Accelograph. Description of the instrument and initial clinical experiences]. / Relaxometrie mit dem Accelograph. Gerätebeschreibung und erste klinische Erfahrungen.

The accelograph, made by Biometer/Danmark is a new myomechanograph. Registration of electromechanical effects is performed by measuring the acceleration of the thumb during N. ulnaris stimulation using an piezoelectric transducer. In addition to train-of-four parameters an intensive neuromuscular blockade can be quantified by posttetanic potentiation. The microprocessor controlled apparatus is easy to use. Using an external printer a complete documentation of relaxometric parameters is provided.

[Effects of intubation anesthesia on the temporomandibular joint]. / Auswirkungen der Intubationsnarkose auf die Kiefergelenke.

Hardly any attention has so far been paid to temporomandibular joint (TMJ) dysfunction after endotracheal intubation. We examined perioperative lesions of the TMJ in 100 patients who underwent operations in areas other than the head and neck. Fifty of these patients were anesthetized with orotracheal intubation; the other 50 were operated under spinal or peridural anesthesia. The orotracheal intubations were carried out with Macintosh laryngoscopes (blatesize 3). Size 32 Kuhn tubes or Magill tubes were used in 25 patients each. Preoperatively and daily for the first 4 postoperative days, we repeated the history and examined the minimal distance between the occlusal edges of upper and lower incisors (SKD), deviations of the mandible during opening and closing movements, and snapping or grinding of the TMJ. We further measured the duration of intubation, technical difficulties, and the number of years of training of the anesthetist. Age, body length, and preoperative findings were compatible in both patient groups. Operating time was 25% longer in the spinal or peridural anesthesia group. Of the 50 patients with orotracheal intubation, 33 demonstrated a reduced ability of maximal oral opening of up to 35% on the 1st postoperative day. Snapping of the TMJ was observed in 80% of the orotracheally intubated patients on the 1st postoperative day, which was 20% above the preoperative value. TMJ grinding showed no significant changes. Two of the 50 intubated patients complained of TMJ pain, another two had occlusal disturbances, and two had a reduced SKD. There were no detectable differences within the group of intubated patients regarding type of tube or experience of the anesthetist.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of prilocaine 2% versus lidocaine 2% with adrenaline in peridural anesthesia. A clinical double-blind study]. / Vergleichende Untersuchung mit Prilocain 2% bzw. Lidocain 2% jeweils mit Adrenalin zur Periduralanaesthesie. Eine klinische Doppelblindstudie.

Sensory and motor blockade as well as formation of methaemoglobin were investigated under controlled double-blind conditions following epidural anaesthesia with prilocaine 2% or lignocaine 2%, each with adrenaline 1:200,000. 20 ml (= 400 mg) of these two solutions were administered to two groups, each consisting of 10 patients. Sensory blockade was tested with the pin prick method, motor blockade with the Bromage score and the rectus abdominis-muscle (RAM)-test. Venous methaemoglobin was determined before and 2,5 h after administration of the local anaesthetic. Times of onset of sensory blockade and motor blockade, as obtained with the RAM-test, were slightly earlier following lignocaine. The intensity of sensory blockade was more marked following prilocaine. The duration of action was somewhat longer following prilocaine. Methaemoglobin always increased following prilocaine, but not following lignocaine. One patient had an increase of methaemoglobin from 0.8 rel% before to 13.8 rel% after administration of prilocaine. The differences of sensory and motor blockade are of secondary importance for clinical practice; while lignocaine shows higher toxicity to the central nervous and cardiovascular system, prilocaine forms methaemoglobin.