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Zusammenfassung Fragestellung Die Inhalation von Perfluorhexan (PFH) führt im Õlsäure-induzierten Lungenversagen am Schaf zu einer Verbesserung der Oxygenierung und der mechanischen Lungenfunktion. Ziel der Untersuchung war es, Effekte von PFH bei der Therapie eines experimentellen ?acute respiratory distress syndrome? (ARDS) über einen längeren Beobachtungszeitraum (4 h) zu untersuchen sowie die Möglichkeit einer schrittweisen Reduktion der inspiratorischen Sauerstofffraktion (F IO 2) in der Behandlungsgruppe zu evaluieren. Methodik Ein experimentelles ARDS wurde bei 12 Schafen mit der intravenösen Gabe von Õlsäure induziert. Nach dessen Induktion erfolgte bei 6 Tieren eine 30-minütige Therapie mit 18 Vol.-% PFH (PFH-Tx), gefolgt von einer 240-minütigen Beobachtungsphase. Im Anschluss wurde, wenn möglich, die F IO 2 schrittweise reduziert mit dem Ziel eines p aO 2-Werts zwischen 100 mmHg und 140 mmHg. Kontrolltiere ( n=6) blieben untherapiert. Blutgasanalysen, hämodynamische und respiratorische Parameter wurden in regelmäßigen Abständen gemessen. Ergebnisse Perfluorhexan führte zu einer Verbesserung der Oxygenierung ( p<0,01) und der mechanischen Lungenfunktion ( p<0,01) bezüglich des Schädigungszeitpunkts. Gleichzeitig kam es zu einer Reduktion des mittleren pulmonalarteriellen Druckes (MPAP; p<0,01) und des Shunts ( p<0,01) im Vergleich zur Kontrollgruppe. Zudem konnte die F IO 2 in der PFH-Tx-Gruppe signifikant gesenkt werden ( p<0,01). Schlussfolgerung Die Therapie eines Õlsäure-induzierten ARDS mit 18 Vol.-% PFH führte zu einer signifikanten Verbesserung des Gasaustausches und der Lungenmechanik und erlaubte im Verlauf die Reduktion der inspiratorischen Sauerstofffraktion. [ABSTRACT FROM AUTHOR]

Zusammenfassung Im Rahmen von Spinalanästhesien (SPA) kann die Ausbreitung der sensorischen und sympathischen Blockade durch Lagewechsel sowohl nach der Anwendung von isobaren wie auch hyperbaren Lokalanästhetika (LA) unvorhersehbar zunehmen. Wir berichten in diesem Zusammenhang über einen 50-jährigen adipösen Patienten, bei dem zur Versorgung einer Unterschenkelfraktur eine SPA mit 17,5 mg 0,5%igem isobarem Bupivacain durchgeführt wurde. Nach 15 min erreichte die Ausbreitung der sensorischen Blockade ihr Maximum bei Th 8. Nach 15° Oberkörperhochlagerung, 35 min nach der intrathekalen Injektion des LA, kam es innerhalb der nächsten 10 min zu einer unbeabsichtigten Zunahme der kranialen Ausbreitung um 10 Segmente bis C 6. Der Patient wurde bradykard, hypoton, respiratorisch insuffizient und musste intubiert und beatmet werden. Die Hämodynamik wurde durch die intravenöse Applikation von Akrinor ®, Atropin und kolloidalen Volumenersatzmitteln rasch stabilisiert. Die anschließende Operation erfolgte ohne Besonderheiten in Intubationsnarkose. Bei Operationsende wurde der Patient bei stabiler Hämodynamik und suffizienter Spontanatmung problemlos extubiert. Unmittelbar nach Extubation erreichte die kraniale sensorische Ausbreitung L 2. Die Kasuistik zeigt, dass es auch nach vermeintlicher Fixierung des LA zu einer unerwarteten Zunahme der Blockade nach Lagewechsel kommen kann, und dass Patienten nach SPA bis zur Remission der Blockade sorgfältig überwacht werden müssen. Die der unbeabsichtigten kranialen Ausbreitung von sensorischer und sympathischer Blockade zugrunde liegenden Pathomechanismen werden diskutiert. [ABSTRACT FROM AUTHOR]

Small, portable hand-held ultrasound devices nowadays enable a widespread use of prehospital point-of-care ultrasound (pPOCUS), which has so far only been used hesitantly, especially in ground-based emergency services. Many critical or even life-threatening conditions or internal injuries can often be better diagnosed or ruled out using pPOCUS, which can enable faster and more suitable goal-directed treatment and hospital transport. This article critically discusses relevant data, clinical benefits, limitations and challenges to be overcome when using pPOCUS for the most important life-threatening situations and aims to call for intensifying training and the extensive use of pPOCUS., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

By implementation of sonography for regional anesthesia, truncal blocks became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety and helps to avoid complications during needle placement. Additionally, complex punctures are possible that were associated with higher risk using landmarks alone. Next to the blocking of specific nerve structures, interfascial and compartment blocks have also become established, whereby the visualization of individual nerves and plexus structures is not of relevance. The present review article describes published and clinically established puncture techniques with respect to the indications and procedures. The clinical value is reported according to the scientific evidence and the analgesic profile. Moreover, the authors explain potential risks, complications and dosing of local anesthetic agents.

Background: Ultrasound guided distal sciatic nerve block (DSB) at bifurcation level shows fast onset and provides excellent success rates. However, its safe performance might be difficult for the unexperienced physician. Just slightly distal to the bifurcation, the tibial nerve (TN) and common fibular nerve (CFN) can be shown clearly separated from each other. Therefore, we investigated if a block done here would provide similar quality results compared to the DSB proximally to the division, with a potentially lower risk of nerve damage., Methods: In this randomized, prospective trial, 56 patients per group received either a DSB distal to the bifurcation "out-of-plane" (dist.) or proximally "in-plane" (prox.) with 30 ml of Mepivacaine 1% each. Success was tested by a blinded examiner after 15 and 30 min respectively (sensory and motor block of TN and CFN: 0 = none, 2 = complete, change of skin temperature). Videos of the blocks were inspected by an independent expert retrospectively with regard to the spread of the local anesthetic (LA) and accidental intraneural injection., Results: Cumulative single nerve measurements and temperature changes revealed significant shorter onset and better efficacy (dist/prox: 15 min: 3.13 ± 1.86/1.82 ± 1.62; 30 min: 5.73 ± 1.92/3.21 ± 1.88; T 15 min : 30.3 ± 3.48/28.0 ± 3.67, T 30 min . 33.0 ± 2.46/30.6 ± 3.86; MV/SD; ANOVA; p < 0.01) combined with a higher rate of subparaneural spread in the dist. group (41/51 vs.12/53; χ2; p < 0,01). Procedure times were similar. There were no complications in either group., Discussion: The subparaneural spread of the LA turned out to be crucial for better results in the distal group. The steep angle using the out-of-plane approach favors needle penetration through the paraneural sheath. The distance between the branches allows the safe application of the LA, so an effective block can be done with just one injection., Conclusion: DSB slightly distal to the bifurcation, in an out-of-plane technique between the TN and CFN, can be done fast, effectively and safe.

Background: To analyze safety issues of regional anaesthesia and analgesia in Germany only a few single center studies are available. Therefore, the German Society for Anaesthesiology and Intensive Care Medicine (Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) and the Professional Association of German Anaesthetists (Berufsverband Deutscher Anästhesisten, BDA) initiated a network for safety in regional anaesthesia. From this the first results on infectious complications will be reported., Materials and Methods: In a Delphi process the documentation of the setup and maintenance of regional anaesthesia and analgesia was agreed with the participants in a working group from the DGAI. After approval by the officially authorized representative for patient data privacy protection a registry was programmed to collect anonymous data. Up to October 2008 data from 6 centers could be analyzed., Results: After testing for plausibility 8,781 regional anaesthesia procedures (22,112 catheter days) could be analyzed. The 5,057 neuraxial and 3,724 peripheral catheter-based procedures were in place for a median of 2.48 days (range 1.0-3.0 days) and 4 severe, 15 moderate and 128 mild infections were recorded. Diabetics were not found to show a statistically significant increase in risk (2.6% compared to 1.9% for non-diabetics: n.s.). Neuraxial procedures seem to have a higher rate of infections than peripheral procedures (2.7% vs. 1.3%, p<0.0001). Multiple punctures of the skin also seem to be associated with a higher infection rate than single skin punctures (4.1% vs. 1.6%, p<0.0001)., Conclusions: Infectious complications of catheter-based regional anaesthesia are common. Strict hygienic standards must therefore be complied with. More data are necessary to calculate risk factors. The registry provided can also be used as a benchmark to reduce these rates further.

Regional anaesthesia generally is considered to be safe. However, reports of complications with different severities are also well known. The scientific working group of regional anaesthesia of the DGAI has founded a network in conjunction with the BDA. With the aid of a registry, we are now able to describe risk profiles and associations in case of a complication. Moreover, a benchmark has been implemented in order to continuously improve complication rates., ((c) Georg Thieme Verlag KG Stuttgart-New York.)

Adequate postoperative pain management is of major importance for a short rehabilitation time after painful orthopaedic surgery. Multimodal pathways have been established to achieve a surgical patient free of pain and complications. Peripheral and central nerve blocks are a fundamental part of these interdisciplinary strategies and are already implemented in orthopaedic surgical care. This article summarises the value of special anaesthetic techniques, especially regional anaesthesia, in orthopaedic surgery and discusses their impact on several postoperative outcome goals.

Introduction: The application of perfluorohexane (PFH) vapor led to an improvement of oxygenation and mechanical lung function in a model of oleic acid-induced ARDS in sheep. The aim of this study was to investigate the effects of PFH on gas exchange over an extended time period and to reduce the invasiveness of ventilation., Method: ARDS was induced in sheep ( n=12) by injecting 0.1 ml/kg body weight oleic acid intravenously. Six sheep were treated for 30 min with 18 vol.% PFH (PFH-Tx) and followed up over a time period of 240 min while untreated sheep ( n=6) served as controls. Subsequently the F(I)O(2) was reduced to generate a p(a)O(2) between 100-140 mmHg. Gas exchange, respiratory and hemodynamic data were collected at regular intervals. Data were analysed using covariance analysis., Results: PFH treatment led to an improvement in oxygenation ( p<0.01) and in mechanical lung function ( p<0.01). Furthermore, mean pulmonary artery pressure ( p<0.01) and shunt ( p<0.01) were lower in PFH-Tx. F(I)O(2) could be reduced in all PFH-treated animals ( p<0.01)., Conclusion: Treatment of oleic acid-induced lung injury with PFH vapor improved oxygenation and mechanical lung function over a extended time period allowing a reduction in the invasiveness of ventilation.

Inadvertent cranial extension of sympathetic and sensory block following posture change during spinal anaesthesia has been reported for isobaric as well as for hyperbaric local anaesthetics. We present the case of a patient who underwent surgical repair of a refracture of the tibia under spinal anaesthesia with 17.5 mg of isobaric 0.5% bupivacaine. The maximum level of sensory block (MLSB) reached T8 after 15 min. Following posture change into a 15 degrees anti-Trendelenburg position 35 min after lumbar puncture, the MLSB increased cranially for 10 segments and reached the C6 level after 10 min of anti-Trendelenburg position. The patient suffered from severe bradycardia and arterial hypotension which were treated with 6% hydroxyethyl starch, atropine and Akrinor. In addition, the patient developed respiratory insufficiency and was therefore intubated and the lungs were mechanically ventilated. The operation was performed uneventfully with the patient under general anaesthesia. At the end of surgery the trachea was extubated, and the patient was awake with stable hemodynamics, sufficient spontaneous ventilation and free of pain. MLSB reached the second lumbar dermatome. This case shows that after assumed fixation of the local anaesthetic an inadvertent extension of the MLSB following posture change is possible. Close surveillance is recommended for patients with central neuraxial blocks until the block is in complete remission. The mechanisms for inadvertent high extension of the MLSB following posture change are discussed.