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  • 1
    Digitale Medien
    Digitale Medien
    Varying anatomical injection points within the thoracic paravertebral space: effect on spread of solution and nerve blockade (2004)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 59 (2004), S. 0 
    Details
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The factors responsible for the spreading pattern of a single paravertebral injection are still uncertain. In this study, 28 patients were randomly assigned to receive a paravertebral injection of radio-opaque dye (10 ml, with or without co-administration of 20 ml of local anaesthetics) either dorsal or ventral to the endothoracic fascia. The point of injection was determined by use of a nerve-stimulator and the radiographic distribution pattern was assessed blindly by a radiologist. Injections made in the more ventral part of the thoracic paravertebral space, supposedly anterior to the endothoracic fascia, resulted in a multisegmental longitudinal spreading pattern, whereas injections made dorsal to the endothoracic fascia resulted in a less predictable cloud-like spreading pattern, with only limited distribution over adjacent segments. The use of a nerve stimulator-guided technique appears to enhance the likelihood of achieving the more desirable longitudinal spreading pattern.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1365-2044.2004.03705.x
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  • 2
    Digitale Medien
    Digitale Medien
    Near fatal pulmonary hypertension after surgical repair of congenital diaphragmatic hernia (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 48 (1993), S. 0 
    Details
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The addition of 10–20 parts per million nitric oxide to the inspired gas was successful in controlling near fatal pulmonary hypertension after surgical repair of a congenital diaphragmatic hernia in a neonate. A preceding prostacyclin infusion was unable to prevent the failure of pulmonary perfusion. No side effect of nitric oxide therapy was observed, and ventilatory support could be substantially reduced as a result of the treatment. On the basis of the striking and lifesaving effects of nitric oxide therapy demonstrated in this child, we believe that nitric oxide treatment will prove to be a major contribution to the management of postoperative pulmonary hypertensive crises.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1365-2044.1993.tb07179.x
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  • 3
    Digitale Medien
    Digitale Medien
    Postoperative nausea and vomiting in paediatric ambulatory surgery: sevoflurane versus spinal anaesthesia with propofol sedation (2001)
    Oxford UK : Blackwell Science Ltd
    Pediatric anesthesia 11 (2001), S. 0 
    Details
    ISSN: 1460-9592
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Background: Descriptive data report a very low rate of postoperative nausea and vomiting (PONV) following spinal anaesthesia in children. In an attempt to corroborate this observation, we designed a prospective randomized study to compare spinal anaesthesia with intravenous propofol sedation (SA) (n=21) to inhalational sevoflurane anaesthesia (IA) (n=19) with regard to PONV and postoperative analgesia in children (aged 3–12 years) undergoing ambulatory inguinal surgery. Results: No difference was found concerning the number of patients experiencing PONV in each group (SA 1/21 versus IA 5/19; P=0.085). However, spinal anaesthesia was associated with a reduced number of PONV episodes (1/21) compared with inhalation anaesthesia (8/19) (P=0.014) and the need for supplemental postoperative analgesia with ketoralac was significantly lower in the SA group (3/21) compared to the IA group (14/19) (P 〈 0.001). Despite these benefits of spinal anaesthesia compared with inhalational anaesthesia, spinal anaesthesia did not decrease the time to discharge from the ambulatory surgery unit [SA 161 (SD 51) min, IA 164 (SD 41) min; P=NS] and the overall PONV experience was rated as ‘no problem’ by all patients, except one, regardless of anaesthetic protocol used. Conclusions: Despite the reduced number of emetic episodes and the better immediate postoperative analgesia associated with spinal anaesthesia, no difference could be identified between the two different anaesthetic protocols regarding time to discharge or overall patient satisfaction. Thus, despite minor advantages associated with spinal anaesthesia with propofol sedation, both anaesthetic regimen appear equally suitable for use in the paediatric outpatient setting.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1046/j.1460-9592.2001.00670.x
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  • 4
    Digitale Medien
    Digitale Medien
    Paravertebral blockade (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 50 (1995), S. 0 
    Details
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The failure rate and complications were studied prospectively in 367 paediatric and adult patients who had received a thoracic or lumbar paravertebral block. The overall failure rate was 10.1%; adults 10.7%; children 6.2%. The frequency of complications were: hypotension: 4.6%; vascular puncture: 3.8%; pleural puncture: 1.1%; pneumothorax: 0.5%. Since these results are similar to those found with alternative methods, e.g. epidural, intrapleural and intercostal blocks, paravertebral block can be recommended as an effective, safe technique for unilateral analgesia in both adults and children.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1365-2044.1995.tb06148.x
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  • 5
    Digitale Medien
    Digitale Medien
    Continuous paravertebral block in children (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 47 (1992), S. 0 
    Details
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Continuous paravertebral block has not previously been described for use in children. This study reports the use of this technique in five patients (aged 7 months to 8 years) scheduled for renal surgery or cholecystectomy. The block was not difficult to perform and provided good intra- and postoperative analgesia. Continuous paravertebral block appears to be a promising technique for pain management in children and might prove a valuable addition in the field of paediatric regional anaesthesia.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1365-2044.1992.tb02336.x
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  • 6
    Digitale Medien
    Digitale Medien
    The caudal boundary of the thoracic paravertebral space (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 47 (1992), S. 0 
    Details
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The caudal limit of the thoracic paravertebral space was examined in 13 human cadavers. The origin of the psoas major muscle was found to completely seal off the paravertebral space below the level of the 12th thoracic vertebra. The possibility of caudal spread of a thoracic paravertebral block below this level through the paravertebral space would appear unlikely.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1365-2044.1992.tb04200.x
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  • 7
    Digitale Medien
    Digitale Medien
    A reply (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1046/j.1365-2044.2002.262619.x
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  • 8
    Digitale Medien
    Digitale Medien
    Somatic paravertebral nerve blockade Incidence of failed block and complications (2001)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 56 (2001), S. 0 
    Details
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The failure rate and complications following thoracic and lumbar paravertebral blocks performed in 620 adults and 42 children were recorded. The technique failure rate in adults was 6.1%. No failures occurred in children. The complications recorded were: inadvertent vascular puncture (6.8%); hypotension (4.0%); haematoma (2.4%); pain at site of skin puncture (1.3%); signs of epidural or intrathecal spread (1.0%); pleural puncture (0.8%); pneumothorax (0.5%). No complications were noted in the children. The use of a bilateral paravertebral technique was found approximately to double the likelihood of inadvertent vascular puncture (9% vs. 5%) and to cause an eight-fold increase in pleural puncture and pneumothorax (3% vs. 0.4%), when compared with unilateral blocks. The incidence of other complications was similar between bilateral and unilateral blocks.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1365-2044.2001.2084-2.x
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  • 9
    Digitale Medien
    Digitale Medien
    Curettage of benign lesions of bone (1985)
    Springer
    International orthopaedics 8 (1985), S. 287-294 
    Details
    ISSN: 1432-5195
    Schlagwort(e): Benign bone lesion ; Curettage ; Multivariate analysis ; Recurrence
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Résumé Dans une étude rétrospective de 115 sujets atteints de diverses tumeurs osseuses bénignes, on a analysé la fréquence des récidives après simple curetage, en relation avec l'âge, le sexe, le type histologique de la tumeur, sa localisation et sa taille, ainsi qu'avec le type de greffe osseuse utilisée lors de l'opération. Tous les malades ont été suivis au moins 2 ans, 131 (85%) 5 ans et 101 (65%) 10 ans ou plus. Le pourcentage global de récidive est de 23%. Toutes sauf une sont survenues dans les six ans qui suivent l'intervention, 80% dans les 3 ans et 49% dans la première année. Le pourcentage global de guérison obtenu par le seul curetage, répété plusieurs fois dans quelques cas, est de 95%. Une chirurgie plus extensive, telle que résection (6 cas) et amputation (1 cas), n'a été nécessaire pour obtenir le contrôle des lésions que chez 5% des malades. Le type histologique et le sexe du patient sont les seuls facteurs statistiquement en rapport avec la récidive, bien que dans les kystes solitaires l'âge du malade soit également corrélé. Un fréquence significativement plus élevée s'observe chez les sujets de sexe féminin en cas de tumeurs à cellules géantes et de kystes anévrysmaux, ainsi que chez les enfants de moins de 8 ans en cas de kyste solitaire. Cette étude de tumeurs bénignes de divers types histologiques, traitées dans un même centre de manière uniforme, montre que la fréquencë des récidives est en rapport étroit avec le type de la tumeur. Le choix du traitement chez des sujets présentant des lésions osseuses bénignes doit dépendre des caractéristiques histologiques de la tumeur. Des techniques chirurgicales extensives ne sont pas nécessaires mais d'autres procédés thérapeutiques peuvent être associés au curetage.
    Notizen: Summary In a retrospective study of 155 patients with different types of benign lesions of bone, the rate of recurrence following simple currettage was analysed in relation to sex, age, histological type, the location and the size of the tumour, and the type of bone graft used at operation. All patients were followed for a minimum of 2 years, 131 (85%) for 5 years and 101 (65%) for 10 years or more. The overall rate of recurrence was 23%. All recurrences except one were within 6 years of the initial operation, 80% within 3 years and 49% within 1 year. The overall rate of cure using curettage as the sole treatment, although repeated several times in some cases, was 95%. Only 5% of the patients required more extensive surgery, such as local resection (6 cases) and amputation (1 case), to control the tumour. The histological type and the sex of the patient proved to be the only factors statistically related to recurrence, although with solitary cysts the age of the patient was also relevant. Significantly higher recurrence occurred with giant cell tumours and aneurysmal bone cysts, in females, and with solitary cysts in patients under 9 years of age. This study of histologically different benign lesions treated in a uniform manner at a single centre shows that the rate of recurrence is strongly related to the type of tumour. The choice of treatment in patients with benign lesions of bone should be dictated by the histological appearance of the lesion. More extensive surgical procedures may not be necessary but other measures may be used in addition to curettage.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00266874
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  • 10
    Digitale Medien
    Digitale Medien
    Design flaw can convert commercially available continuous syringe pumps to intermittent bolus injectors (1997)
    Springer
    Intensive care medicine 23 (1997), S. 998-1001 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Key words Children ; Infusion ; intravenous ; Infusion pumps ; Technology ; medical
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective: To investigate if unexpected behaviour of neonatal and paediatric patients connected to syringe pumps could be explained by transient elevation of these devices. Design: Five different commercially available syringe pumps were set at an infusion rate of 1 ml/h and then subjected to a vertical displacement manoeuvre (height 1 m). The actual delivered infusion volumes in association with the displacement manoeuvre were measured by a high precision weight scale connected to a computer. Setting: A medical technology laboratory in a university hospital. Measurements and results: Elevation of the devices resulted in a rapid bolus injection of 0.19–2.28 ml. Returning the devices to their original positions resulted in an aspiration into the system of 0.06–0.34 ml. The times both for bolus injection and for aspiration into the system were less than 1 min in all cases. The up-down manoeuvre was followed by a period with zero infusion ranging from 8 to 105 min. Conclusions: Design flaws in the construction of syringe pumps can expose patients to substantial danger following vertical displacemet if potent drugs are being infused. If potent drugs are infused, care should be taken not to change the vertical position of the syringe pump even for short periods of time. Before buying new equipment, the authors recommend that the delivery characteristics of these devices should not only be tested during ordinary bench testing but should also include the reaction to a vertical displacement manoeuvre.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001340050445
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