[Para-spinal analgesia in obstetrics].

The use of regional analgesia and anesthesia in obstetrics has been established since the end of the 19th century. According to an agreement between German societies of anesthesiologists and obstetricians, regional anesthesia may be performed by both anesthesiologists and obstetricians under certain preconditions. At the RWTH Aachen hospital, the responsibility for different anesthetic techniques is divided between anesthesiologists and obstetricians in order to reduce legal risks.

[Cerebrovascular abnormalities in pregnancy].

A 37-year-old pregnant woman without neurological history was admitted in the 21st week of pregnancy for multiple seizures. Angiography confirmed the diagnosis of cerebral angioma. The patient decided to continue with her pregnancy; caesarean section under regional anesthesia via an epidural catheter was uneventful.

[Arousal in various analgosedation schedules].

The patterns of recovery of patients who received seven different analgesic and sedative treatments were investigated with regard to the time at which the subjects awoke. For observations of the neurologic status, we developed a special score. The analgesic and sedative therapies were given at three various doses.

[Analgosedation of the ventilated intensive care patient].

Seven different schemes for analgesic anaesthesia were investigated for their clinical applicability, potential side effects, and impacts on circulation parameters of the systemic and pulmonary (peripheral) circulation as well as on the intracranial pressure. In all, so patients per group were treated. The results revealed different reactions of patients, such as a higher incidence of disturbances of the autonomic nervous system and excitation after medication withdrawal.

[Comparative studies of the postoperative phase following opioid analgesia using fentanyl and alfentanil within the scope of extracorporeal shockwave lithotripsy].

30 patients (ASA Class I-III) received opioid analgesia with fentanyl and alfentanil for extracorporeal shock wave lithotripsy. Average doses were 0.41 mg for fentanyl and 4.

Opioid analgesia in extracorporeal shock wave lithotripsy: fentanyl versus alfentanil.

More than 1,600 patients have been treated by extracorporeal shock wave lithotripsy (ESWL) under fentanyl analgesia without any complications or severe side-effects. As secondary respiratory depression is still under discussion, we investigated the value of alfentanil--a short-term acting opioid--with special interest in its efficacy and side-effects. Neither fentanyl nor alfentanil significantly influenced blood pressure, respiratory rate and blood gases.

[Intracranial pressure and circulatory parameters with positive end-expiratory pressure (PEEP). The possibility of drug modification].

In patients who have head injuries as well as injuries involving other organ systems, especially those of the thorax and upper abdomen, conflict can arise between the need to ensure adequate ventilation and the simultaneous need to protect the brain against further increases in intracranial pressure. Positive end-expiratory pressure (PEEP) ventilation, in particular, is suspected of causing the intracranial pressure to rise. Our study of the effects of a combination of anaesthetics on animals, was designed to investigate whether, the negative effects of PEEP ventilation on both intracranial pressure and on various circulatory parameters could be prevented.

[Anesthesiologic aspects of extracorporeal shockwave lithotripsy (ESWL)].

Anesthesiological considerations are discussed on the basis of the limited literature available and our own experience with more than 2000 ESWL treatments. Guidelines concerning anesthesia technique and ESWL treatment of renal and ureteral stones are outlined and compared to our own results and those in the literature. The following techniques are discussed: intubation anesthesia with halogenated carbohydrogens (Fluothane, Ethrane), intubation anesthesia with Fluothane/Ethrane plus opiates, neuroleptic anesthesia, catheter peridural anesthesia (lumbar/thoracic), opiate analgesia and high frequency jet ventilation.

[Omphalocele and gastroschisis: problems in intensive medical treatment].

Aetiologically and pathognomically, omphalocele and gastroschisis are different forms of occlusive disorders in the anterior abdominal wall of newborns. Their prognosis has clearly improved in recent years, owing to progress in surgical and conservative treatment, primarily on account of improved intensive medical care of the children concerned. Courses and survival rates of newborns with either malformation have proved to depend strongly on the initial condition of the patients.

[Amrinone in catecholamine refractory heart failure in septic shock].

The effect of the new positive inotropic and vasodilatator bipyridine-derivate Amrinon on catecholamine-refractive heart insufficiency in septic shock is described. A bolus dose of 1 mg/kg b.w.

[Experiences with a new double-lumen venous catheter in anesthesia and intensive care medicine].

A new double-channelled catheter with one main lumen and one accessory small lumen is described. The different ranges of application and the advantages are discussed. Flow rates through the two channels are measured and compared with the well-known "Cavafix"-system.

[Use of etomidate within the scope of neurosurgery].

The effect and the applications of Etomidate pro infusion (125 mg/ml) are discussed under special consideration of neurosurgical patients. Besides the application for anaesthesia, the administration of Etomidate pro infusion in the intensive-medical range for sedation, reduction of cerebral pressure and as an anticonvulsant is dealt with. The possibility of an adrenal insufficiency under the action of Etomidate pro infusion is discussed on the basis of the literature controversial to this subject.

[Alfentanil for neuroleptanesthesia in short operations].

Alfentanil, a potent short acting analgetic, is used for short operations instead of fentanyl as a neurolept anaesthesia agent. The action of this form of anaesthesia is described. As initial dose of alfentanil we used 25 micrograms/kg b.

[Use of a new double lumen catheter within the scope of intensive care medicine].

A new double-channelled catheter with one main canal lumen and an accessory small lumen and its different ranges of applications are discussed. Reactions of incompatibility and possible changes in efficacy between drugs and infusions can be provided with this new form of a central-vein-catheter.

[Etomidate as an anticonvulsive agent].

Experiences with etomidate as an agent with hypnotic, brain protective and anticonvulsive effects are discussed. The application of etomidate is described at one patient with epilepsy and withdrawal symptoms after resuscitation.

[Use of alfentanyl in short-term anesthesia. Initial results].

The administration of the new opiate-analgetic alfentanil in combination with etomidate supplemented by N2O/O2 for short anaesthesia is described. The influence on blood pressure, heart rate, paO2, paCO2, rate-pressure-product (RPP) and glucose rate has been investigated. In the intraoperative and early postoperative period, the cardiac and respiratory system was unchanged.

[Therapy of alcohol withdrawal delirium with a new hypnotic].

The treatment of alcohol withdrawal symptoms which suddenly appear after an operation, is discussed. Therapy with etomidate as long term sedation is described. 500 mg of etomidate (125 mg circumflex or equal to 1 ml) soluted in 50 ml physiological saline was given by perfusor (0.

[Infusion-etomidate-anaesthesia. II. The influence of different serum levels (author's transl)].

The influence if etomidate-infusion-anaesthesia on different serum levels of GOT, GPT, Na+, K+, urea, creatinine and glucose in the postoperative period was examined. There was only a decrease in K+. Although the decrease was significant (p less than 0.

[Etomidate for long term administration (author's transl)].

Etomidate in a new more concentrated solution given in 50 ml NaCl 0.9% was administrated to two groups of patients for prolonged sleep over 48-60 hours. The first group of patients got withdrawal symptoms after several operations.

[The influence on the cardiovascular system of etomidate infusion anaesthesia combined with fentanyl/nitrous oxide (author's transl)].

Blood pressure and heart rate after the application of etomidate, soluble in alcohol 70% (a ml approximately or equal to 125 mg) and supplemented by fentanyl under controlled respiration with N2O/O2 as an continuous infusion for anaesthesia has been investigated during surgery. After the administration of fentanyl/etomidate (Hypnomidate)/succinylcholine the patients were intubated. Then the infusion of etomidate began with 1.

[Etomidate-infusion-anaesthesia. I. Haemodynamics and blood gases analyses in the early postoperative period (author's transl)].

The influence of etomidate-infusion anaesthesia on blood pressure, heart rate and blood gases in the early postoperative period has been investigated on 14 patients. An infusion model for etomidate is described. Blood pressure and heart rate remained unaltered.