[Palliative sedation in a man with oral cancer; the Royal Dutch Medical Association guidelines not always sufficient].

Background: Palliative sedation is an effective treatment option in patients with refractory symptoms in the last phase of life. In 2009 the Royal Dutch Medical Association (KNMG) published revised guidelines. The dosage of propofol recommended in these guidelines is, however, based on one single study.

[Outpatient preoperative examination by the anesthesiologist. II. Patient satisfaction].

Objective: To determine patient satisfaction after the reorganisation of the preoperative screening.

Setting: General Hospital De Weezenlanden, Zwolle, The Netherlands.

Design: Retrospective patient interview.

[Outpatient preoperative examination by the anesthesiologist. I. Fewer procedures and preoperative hospital days].

Objective: To study the effect of the reorganisation of the preoperative screening on the volume of laboratory and function tests, and on preoperative hospital days.

Setting: General Hospital De Weezenlanden, Zwolle, The Netherlands.

Design: Retrospective study.

Local anaesthetic block therapy of posttraumatic neuralgia of the infraorbital nerve.

The pathogenesis, as well as the results of treatment in 12 patients with neuralgia of the infraorbital nerve are discussed. Patients were treated by means of local anaesthetic nerve blocks, or when this was unsuccessful, by transcutaneous nerve stimulation and or tricyclic antidepressive drugs. In this way, the results were good in previously untreated patients, while they were moderate in patients in whom an attempt to treat with surgery had been carried out earlier.

Delayed air embolism during vascular surgery.

Air embolism occurred in a 25-year-old patient undergoing surgery for reconstruction of the subclavian vein. Air embolism probably occurred twice, the second time at about an hour after closure of the vein. The cause of this delayed air embolism is discussed.

Treatment of venous air embolism with papaverine.

Two cases of venous air embolism are described. One case occurred in a 12-year-old girl operated for ureteroileo-cutaneostomy; the other case occurred in a 44-year-old patient who underwent a hemihepatectomy. The haemodynamic and pulmonary consequences were successfully treated with intravenous papaverine.

Cardiorespiratory effects of the sitting position in neurosurgery.

The hemodynamic and respiratory effects of raising patients from the supine into the sitting position for neurosurgical procedures were investigated in fifteen patients under fentanyl-nitrous oxide anesthesia. The change of position caused a significant decrease in the cardiac output and in the mean arterial blood pressure. An increase in the systemic vascular resistance and in the pulmonary vascular resistance occurred.

Pulmonary edema following air embolism.

Venous air embolism is a major hazard during surgical procedures in the sitting position and is known to cause acute pulmonary edema in animal experiments (6, 7, 17). In man some cases of pulmonary edema immediately following air embolism have been described (10, 15, 16). In this case report we present a patient that developed pulmonary edema which became apparent several hours after the occurrence of air embolism.

The capnograph, a reliable non-invasive monitor for the detection of pulmonary embolism of various origin.

The wash-out curve in the capnogram is known to be a sign of pulmonary air embolism. This characteristic pattern is also seen in the case of pulmonary embolism of other nature. Capnographic recordings were studied retrospectively and 22 wash-out curves were found.