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We report on a case of catheter-related thrombosis after 7‑day catheter placement during intravascular temperature management (IVTM), in spite of the use of prophylactic anticoagulants. There were no clinical sequelae. According to the literature, occult thrombosis during ITVM could be more frequent than previously reported and dedicated monitoring for potential thrombosis may be indicated. However, a study comparing IVTM with surface cooling found no differences in clinical outcome. Therefore, n either of the methods can be recommended over the other. Further studies should evaluate the rate of occult thrombosis during the use of both cooling methods.

Selecting a route for drug administration during CPR requires consideration of the speed with which access can be obtained, the technical difficulties involved in performing the procedure, the associated risk of complications, delays in drug delivery to the central circulation, and the duration of effective drug levels following injection. The peripheral venous route is the safest method, and drug delivery can be enhanced by a fluid bolus after injection of the medication. The circulation time is shortest after central venous injection, but there is some risk of complications. The femoral route is associated with a high incidence of unsuccessful catherization. The endotracheal tube provides an accessible route for administration of most drugs, but peak concentrations are lower than those obtained by other routes. While the results are almost the same as an intravenous injection, the intraosseous route is currently underrepresented in clinical practice. This method must not only be considered in pediatric patients, but in adult patients as well.

Total intravenous anaesthesia with propofol and alfentanil is an established alternative to inhalation anaesthesia for intracranial neurosurgical procedures. Its usefulness has been somewhat overshadowed by reports of seizure-like movements, both during anaesthesia and in the recovery period. These can be related to the use of either anaesthetic agent, but true epileptogenic properties still remain to be demonstrated in man. Opioid-induced rigidity is a well known phenomenon and must not be mistaken for an epileptic seizure. Myoclonic motor activity can be observed even under physiological conditions, e.g. sleep. Almost all anaesthetic agents have been found to produce "epileptic" EEG changes (spikes, polyspikes, spike-wave complexes), but in man these have never been correlated to motor reactions. Propofol's pro- or anticonvulsive action is unclear. While some groups found shortened convulsing times in patients undergoing electroconvulsive therapy with propofol instead of methohexitone, others have reported activation of epileptogenic foci in the EEGs of known epileptic patients. A synergistic effect of propofol and alfentanil in the generation of seizure-like movements cannot be excluded. Whether seizure-like movements indicate a true "epileptogenic potency" of the anaesthetic drugs or are related to other phenomena remains to be studied. Electro-encephalographic monitoring during anaesthesia as well as careful observation and documentation of motor reactions may contribute to elucidation of the problem. We report a case of seizure-like movements during propofol-alfentanil anaesthesia for an elective craniotomy. A 52-year-old patient presented with a history of headaches of increasing frequency. A CT brain scan demonstrated a tumor in the left occipital region.(ABSTRACT TRUNCATED AT 250 WORDS)

We evaluated a 3-year clinical follow-up in 53 patients with unsuccessful PTCA, due to failure to reach the lesion (control-group) in comparison to a "matched pairs" group of 53 patients, in whom PTCA had been performed (PTCA-group). There were no deaths in the PTCA-group compared to 3 deaths (5.7%) in the control-group (ns). Two patients (3.8%) and three patients (5.7%), respectively, suffered an acute transmural myocardial infarction during the follow-up period (ns). Coronary artery bypass grafting (CABG) had been performed in five patients (9.4%) following PTCA, and in 17 patients (32.1%) of the control-group (p less than 0.002). The overall rate of serious cardiac events (death, myocardial infarction or CABG) amounted to 13.2% (seven patients) in the PTCA-group and to 43.4% (23 patients) in the control-group (p less than 0.002). Only in the PTCA-group was a repeat PTCA performed in 15 patients (28.3%) with restenosis (p less than 0.00003). 35 of 53 patients in the PTCA-group (66%) and 27 of 50 survivors in the control-group were free of symptoms at the end of follow-up (ns). These results demonstrate that PTCA in patients with single-vessel disease is followed by a marked reduction of serious cardiac events, predominantly of bypass-operations, but the necessity of a second PTCA-procedure in case of restenosis has to be considered.