Efficacy of ketamine in anesthetic dosage for the treatment of refractory complex regional pain syndrome: an open-label phase II study.

Objective: Advanced complex regional pain syndrome (CRPS) remains very difficult to treat. While subanesthetic low-dose ketamine has shown promise in early localized CRPS, its use in advanced CRPS has not been as effective. Since ketamine's analgesic potency and duration of effect in neuropathic pain are directly dose-dependant, we investigated the efficacy of ketamine in anesthetic dosage in refractory CRPS patients that had failed available standard therapies.

A pilot open-label study of the efficacy of subanesthetic isomeric S(+)-ketamine in refractory CRPS patients.

Objective: Complex regional pain syndrome (CRPS) is a severe neuropathic pain state that is often disproportionate to the initial trauma. Associated features are autonomic dysregulation, swelling, motor dysfunction, and trophic changes to varying degrees. Despite a multitude of treatment modalities, a subgroup of CRPS patients remain refractory to all standard therapies.

Complete recovery from intractable complex regional pain syndrome, CRPS-type I, following anesthetic ketamine and midazolam.

Objective: To describe the treatment of an intractable complex regional pain syndrome I (CRPS-I) patient with anesthetic doses of ketamine supplemented with midazolam.

Methods: A patient presented with a rapidly progressing contiguous spread of CRPS from a severe ligamentous wrist injury. Standard pharmacological and interventional therapy successively failed to halt the spread of CRPS from the wrist to the entire right arm.

[Pediatric cases in preclinical emergency medicine: critical aspects in the range of missions covered by ground ambulance and air rescue services].

Background: The aim of this study was to demonstrate differences in structure and severity of pediatric emergencies treated by aeromedical (air rescue) or ground ambulances services. Conclusions for the training of emergency physicians are discussed.

Patients And Methods: In a 3-year study period, a total of 9,274 pediatric emergencies covered by the ADAC air rescue service are compared to 4,344 pediatric patients of ground ambulance services in Saarland.

[Preclinical care of trauma patients in air rescue. Results of the medical quality management for patients with severe head injury and polytrauma in the years 2000 and 2001].

In a retrospective study of mission data of ADAC Air Rescue of the years 2000 and 2001 the quality of preclinical care of 1,946 patients with severe head injuries and 1,878 polytraumatized patients was examined. The actual preclinical care of these patients was compared with a catalogue of eleven thesis-like recommendations. These recommendations were previously derived from corresponding publications of national and international specialist companies and were introduced in a binding manner by the senior doctors of the participating air rescue centres.

[Prerequisites for outpatient treatment using general anesthesia].

The possibility of profound preoperative examination by an experienced anesthesiologist, the cooperation of dentists, oral and maxillo-facial surgeons, anesthesiologists, pediatricians, internal specialists and family doctors, careful planning, conduction and supervision of anesthesia and postoperative treatment in a recovery room are essential in safe outpatient treatment under general anesthesia in the field of oral and maxillo-facial surgery. In case of unexpected postoperative complications patients have to be hospitalized. All the aforementioned requirements in respect of staff, apparatus and rooms must be fulfilled.

[Mechanical ventilation in an anesthetic circle system using the lowest tidal volume--studies of 3 anesthesia ventilators in a lung model and an animal experiment].

No anesthesia ventilator attached to a circle system is manufactured for use in neonates. However, a small bellows can be supplied for the following anesthesia ventilators: Spiromat NS 656 (NS), Ventilog 2 (V2) and AV1 (Draeger Co.) We investigated the minimal tidal volume delivered by each of the three ventilators.

[Respiratory emergencies in childhood].

The most important maneuvers of primary treatment of respiratory emergencies in childhood are the securement of free airways, provision of oxygen and (medicamentous) tranquilization of the child. The most common causes of these emergencies are fulminant (infectious) diseases of the upper and lower airways, a particularly significant aspect being the considerable mucosal swelling as compared with adults. Aspiration of foreign bodies is a further cause of acute, life-threatening respiratory distress.

The role of alpha 1-adrenoceptors in adrenaline-induced hyperkalaemia.

The hyperkalaemic action of adrenaline was investigated in 44 anaesthetized domestic pigs. Plasma and epicardial concentrations of K+ were measured, in the latter case with an ion-selective electrode. Adrenaline 10 micrograms kg-1 caused a rapid increase in the plasma concentration of K+ from 4.

[Perioperative infusion therapy in children].

An incorrect fluid therapy can lead to serious complications considerably more rapidly in children, especially in newborns and infants, than in adults. The pediatric patient has a limited range of compensation for maintenance of fluid and electrolyte balance. Precise knowledge of the physiological age-dependent fluid balance, i.

[Comparative humidity measurements in semiclosed and semiopen systems with the additional use of artificial noses].

The administration of dry anesthetic gases for ventilation lasting more than 1 h leads to morphological changes of the tracheobronchial epithelium that may cause postoperative pulmonary complications. Therefore, additional humidification is suggested for ventilation during anesthesia, particularly when using semiopen breathing systems. Recommendations concerning the use of semiclosed systems are controversial: previous studies have shown sufficient humidification on the one hand, and insufficient water content in the inspired air on the other hand.

[Pharmacodynamics of vecuronium in infants during intravenous induction of anesthesia with ketamine].

The pharmacodynamic effects of vecuronium in children aged 1 to 6 years were investigated after intravenous induction of anaesthesia with ketamine, using an initial dose of vecuronium of 0.08 mg/kg body wt. 0.

[Pulse oximetry as a continuous, noninvasive monitoring procedure. Comparison of 2 instruments].

Pulse oximetry allows continuous registration of the arterial oxygen saturation by using the light absorption in a wave range between 600 and 1,000 nm. In addition the peripheral pulse is determined by a plethysmographic method. Two new devices, the Biox III pulse oximeter and the Nellcor pulse oximeter were compared for the following three items: 1.

[Endotest--a simple method for the monitoring of internal pressure of the tube cuff].

The Endotest is a simple device for monitoring the cuff pressure of an endotracheal tube. No complications could be observed during a 6 month period of usage in the daily routine. We found the handling very good and cuff pressure monitoring very useful.

[Massive intraoperative lung embolism caused by the introduction of a telescope pin (Bailey-Dubow pin) in a child with osteogenesis imperfecta].

We report the case of a massive pulmonary embolism in a three year old boy with osteogenesis imperfecta during a closed insertion of a Bailey-Dubow-rod. An increased intramedullary pressure with consecutive entering of medullary particles or air into the blood stream due to the insertion of the Bailey-Dubow-rod is discussed as the cause of the pulmonary embolus.

[The semi-closed filter circuit].

In a semi-closed circle system, the inspiratory and expiratory limbs are completely separated and part of the patient's expired air recirculates. CO2 rebreathing is prevented by CO2- absorption with soda lime, which is always incorporated in such a circle. The inspiratory and expiratory valves ensure that gas flow is unidirectional and also prevent rebreathing, even at tidal volumes of 10 ml and ventilation frequencies of 60 c .

[Possibilities and limitations of ventilation monitoring during anesthesia of the newborn and infants].

The following methods for monitoring the ventilation in general anaesthesia can theoretically be applied for neonates and small infants: The use of a precordial stethoscope, measurements and observation of the ventilation pressure, analysis of the inspiratory oxygen concentration, measurement of the expiratory volume, analysis of end-tidal CO2, transcutaneous O2 and CO2 measurement and blood gas analysis. These methods are evaluated and their limitations discussed. Special attention is paid to the application of these methods used in the different paediatric anaesthetic systems.

[Behavior of plasma amino acids, blood sugar, insulin and glucagon in the early post-traumatic phase with sole substitution of fluid and electrolytes].

The findings on the changes in amino acid metabolism and hormonal regulation after severe trauma and the conclusions draw from these are rather controversial. It is well documented that even small amounts of carbohydrates may significantly influence amino acid and carbohydrate metabolism especially in stress situations. Very few studies have been carried out on polytraumatized patients given an absolutely carbohydrate-free diet however.

[Post-traumatic metabolism--bases and clinical aspects].

In order to rationalize the nutritional therapy of polytraumatized patients we have developed a concept to explain the humoral response and subsequent metabolic reactions to trauma, which is based on current reports in the literature and our own investigations. Three separate phases should be defined. a) The acute phase: catecholamines dominate in the initial phase following severe trauma.

[Blood glucose, ACTH, cortisol, T4, T3 and rT3 after cholecystectomy. Comparative studies of continuous peridural anesthesia and neuroleptanalgesia].

15 patients (12 women and 3 men) undergoing cholecystectomy were randomized into two groups. 8 patients were operated on under continuous thoracic epidural anaesthesia in combination with light general anaesthesia. Postoperatively they were kept painfree by continuous infusion of an 0.

[The stress reaction in knee operations under continuous peridural anesthesia in comparison with neuroleptanalgesia].

30 patients undergoing knee-operations were randomized in two groups. 15 patients were operated on under neuroleptanalgesia. Piritramid was given postoperatively.