Breast surgery and peripheral blocks. Is it worth it?

Purpose Of Review: The objective of this review is to identify the potential of peripheral nerve blocks established over the last years for perioperative pain management in breast surgery. These new blocks will be discussed with respect to their clinical effect and necessity.

Recent Findings: After case reports and cadaver studies for the Pecs block and its variations sufficient clinical data from randomized controlled trial (RCT) and meta-analyses exist now.

[Modification of perioperative psychiatric drug therapy].

Apart from cardiovascular, pulmonary and metabolic drugs, many patients scheduled for surgery are taking antidepressive or antipsychotic drugs. Some of these psychiatric drugs may interfere with anesthetics. The anesthesiologist has to decide whether or not to continue the psychiatric medication during the perioperative period.

[The DGAI training module 2 in anaesthetic focussed sonography: vascular sonography].

Modul 2 will provide the theory and practical training of the sonographically guided puncture of central and peripheral veins and arteries. In doing so patients of all age groups are taken into consideration. Combined with the content of the other modules this series of workshops, which was initiated by our society, might be a first step in defining a new core competency of our specialty.

[The DGAI training module 3 in anaesthetic focussed sonography: neurosonography].

Identification of the right puncture site and the target structures are mandatory in performing nerve blocks. Ultrasound is a new method, that visualizes target structures as well as the injection and spread of local anaesthetic solution. The presented module 3 neurosonography is part of the didactic concept "anaesthesiology focussed sonography" developed by the german society of anaesthesiology and intensive care.

Delayed systemic air embolism in a child with severe blunt chest trauma treated with high-frequency oscillatory ventilation.

Purpose: Trauma is the leading cause of death in children over one year of age. Even with optimal field care, blunt chest trauma with hemoptysis is a potentially fatal injury due to exsanguination or arterial air embolism. Most often, cardiovascular collapse that is unresponsive to therapy develops shortly after endotracheal intubation and initiation of positive pressure ventilation.

[Regional anesthesia as a useful alternative to general anesthesia? Overview of the current data].

Neuromuscular disorders are rare and often not very well diagnosed diseases. They can be separated in prejunctional, junctional or postjunctional diseases. General anesthesia is connected with a higher risk, therefore regional anesthesia could often be regarded with favour and could be a safe alternative.

Ultrasound use in non-cardiac surgery.

Ultrasound is used in anaesthesia for diagnostic and interventional reasons. This article gives the anaesthesiolgoist an overview about the relevant indications for ultrasound in non-cardiac surgical patients. Other chapters will focus in more detail on different aspects of ultrasound use in non-cardiac anaesthesia.

Interscalene brachial plexus block for open-shoulder surgery: a randomized, double-blind, placebo-controlled trial between single-shot anesthesia and patient-controlled catheter system.

Introduction: Interscalene brachial plexus block (ISB) is widely used as an adjuvant regional pain therapy in patients undergoing major shoulder surgery and has proved its effectiveness on postoperative pain reduction and opioid-sparing effect.

Method: This single-center, prospective, double-blind, randomized and placebo-controlled study was to compare the effectiveness of a single-shot and a patient-controlled catheter insertion ISB system after major open-shoulder surgeries. Seventy patients were entered to receive an ISB and a patient-controlled interscalene catheter.

Acute respiratory distress induced by repeated saline lavage provides stable experimental conditions for 24 hours in pigs.

Surfactant depletion is most often used to study acute respiratory failure in animal models. Because model stability is often criticized, the authors tested the following hypotheses: Repeated pulmonary lavage with normal saline provides stable experimental conditions for 24 hours with a PaO2/FiO2 ratio < 300 mm Hg. Lung injury was induced by bilateral pulmonary lavages in 8 female pigs (51.

An in-vivo metabolic test for detecting malignant hyperthermia susceptibility in humans: a pilot study.

Introduction: In vitro contracture testing to diagnose malignant hyperthermia (MH) susceptibility requires a muscle biopsy, which may be associated with severe side effects for the patient. After investigation of several different protocols, we present a less invasive metabolic test that involves IM injection of caffeine and halothane, and subsequent measurement of interstitial lactate to differentiate between MH susceptible (MHS) and MH non-susceptible (MHN) individuals.

Methods: Two microdialysis probes with attached microtubing for trigger injection were inserted into the lateral vastus muscle of eight previously diagnosed MHS patients (representing three genetic variants Gly2434Arg, Thr2206Met, and Arg614Cys), seven MHN patients, and seven control individuals.

[Modification of perioperative drug therapy in cardiovascular, pulmonary or metabolic disease].

Almost 50 % of all patients that are evaluated preoperatively by an anesthesiologist are receiving concurrent medication. Many of the prescribed drugs can be omitted during the perioperative period. However, perioperative cessation of certain drug therapies may cause decompensation of primarily compensated diseases.

Comparison of arterial and central venous cannulations using ultrasound guidance in pigs.

Objective: To evaluate the feasibility of ultrasound guided vascular access in pigs by comparing central venous and arterial cannulation techniques.

Animals: Twenty-two healthy female Pietrain pigs, 14-18 weeks old and weighing 51.1 +/- 4.

Intramuscular injection of sevoflurane detects malignant hyperthermia predisposition in susceptible pigs.

Background: The authors hypothesized that intramuscular sevoflurane injection allows diagnostic differentiation between malignant hyperthermia-susceptible (MHS) and -nonsusceptible (MHN) pigs by measurement of intramuscular lactate and carbon dioxide partial pressure (PCO2), and that dantrolene reduces the sevoflurane-induced PCO2 increase.

Methods: With approval of the local animal care committee, microdialysis probes with attached microtubing for sevoflurane injection were placed in the adductor muscles of nine MHS and six MHN pigs, and PCO2 probes with microtubing were positioned in the triceps muscle of eight MHS and six MHN pigs. After equilibration, sevoflurane boluses at different concentrations and a sevoflurane-dantrolene bolus were injected synchronously.

[Paediatric anaesthesia for neurosurgical procedures].

Paediatric neurosurgical procedures request special considerations for the anaesthetic management. Due to patients age and diagnostic findings certain therapeutic procedures are performed under anaesthetic care. Main reasons for craniotomy are hydrocephalus, intracranial tumors and craniofacial synostosis.

The contribution of arterio-venous extracorporeal lung assist to gas exchange in a porcine model of lavage-induced acute lung injury.

This prospective large-animal study was performed to evaluate the contribution of arterio-venous extracorporeal lung assist (AV-ECLA) to pulmonary gas exchange in a porcine lavage-induced acute lung injury model. Fifteen healthy female pigs, weighing 50.3 +/- 3.

[Ultrasound techniques in anesthesiology--guided vascular access using sonography].

In anaesthetic practise ultrasound can facilitate cannulation of veins and arteries not only in adults but also in children. It is the main advantage and safety feature of this technique, that the targeted vessels and the surrounding anatomical structures are visualized and that the needle is advanced under continuous observation. Moreover, its systematic use can reduce the rate of unsuccessful cannulation attempts, which can be caused by anatomical variations or thrombi, occluding the targeted vessel.

[Ultrasound-guided peripheral nerve blockade].

Without miniaturization resulting in affordable hand-held ultrasound systems, ultrasound-guided regional anaesthesia would not be practicable. Nowadays facilitation of nerve blockade by means of ultrasound is achievable even in remote locations. Non-traumatic technique, visualisation of nerves, surrounding structures and the ability to assess the spread of the injected local anaesthetic combined with a high and predictable success rate are the major advantages when ultrasound is used in regional anaesthetic practise.

Sonographic imaging of the sciatic nerve and its division in the popliteal fossa in children.

Background: High resolution ultrasound is a possible option for anesthetists to detect nerves. We tested the possibility of imaging the sciatic nerve and its division into the tibial and peroneal part using high resolution ultrasound in children.

Methods: Twelve children up to 45 kg body weight were randomly selected.