[Persisting respiratory depression following intrathecal administration of morphine and simultaneous sedation with midazolam]. / Langanhaltende Atem- depression nach intrathekaler Morphinapplikation und gleichzeitiger Sedierung mit Midazolam.

A 72-year-old patient received 0.1 mg morphine by the intrathecal route and 2 x 1.5 mg midazolam as adjuvant therapy. Severe respiratory depression and somnolence supervened 3.5 h later, which lasted over the next 24 h and necessitated intubation and mechanical ventilation. Continuous administration of >6 mg naloxone to antagonize the supposed effect of the morphine had no effect. The patient's condition was not normalized until a single dose of 0.3 mg flumazenil was administered. For the time being, especially in the case of elderly patients, we recommend that strict indications are adhered to when intrathecal administration of morphine is considered and that less than 0.1 mg morphine is given. Diazepines should be avoided. Respiration should be monitored for quite some time.

[The laryngeal mask--a valuable instrument for cases of difficult intubation in children. Anesthesiologic management in the presence of Pierre-Robin syndrome]. / Die Kehlkopfmaske--ein wertvolles Instrument bei erschwerter kindlicher Intubation. Anästhesiologisches Management bei Vorliegen eines Pierre-Robin-Syndroms.

UNLABELLED: In cases of craniofacial and mandibulofacial malformations, which are mostly treated during childhood, difficult intubation conditions must generally be expected. In such cases, the laryngeal mask airway (LMA) an alternative instrument for use in endotracheal intubation is a new aid for ventilation. In certain instances, it can be used alone to induce general anaesthesia. Reports of endotracheal intubation by means of the LMA in adults have also been published. CASE REPORT: In our case, a 6-year-old boy with Pierre-Robin syndrome (triad: micrognathia, broad palatoschisis, glossoptosis) needed dental resetting. After induction of anaesthesia in this very cooperative boy with thiopentone and fluothane and relaxation with succinylcholine, it was not possible to examine the hypopharynx by laryngoscopy preparatory to nasal intubation as usual. Repeated blind attempts at nasal intubation (again with spontaneous breathing) failed, as did the attempt at fibreoptic bronchoscopic intubation, because of the narrow anatomical conditions. Finally, a laryngeal mask airway (LMA; size 2) was introduced, and as a result of this ventilation was achieved. However, endotracheal intubation was required for performance of the surgical resetting. With the fibreoptic bronchoscope, we could verify the central position of the LMA over the glottis. A tracheal tube (size 4) was inserted across the laryngeal airway without optic control. The tube connector was disconnected and a normal guide inserted into the tube to remove the LMA. The dental resetting was also performed by oral intubation. CONCLUSION: Therefore, the LMA is not only a ventilation aid, but also a valuable tool in difficult intubation conditions. In our opinion, it is necessary to provide this tool in every anaesthetic unit.

[Patient-controlled analgesia. A technical toy or a contribution to the treatment of pain?]. / Patientenkontrollierte Analgesie. Eine technische Spielerei oder eine Bereicherung der Schmerztherapie?

PCA (patient-controlled analgesia) was used to treat postoperative pain after general surgery and gynecological operations in a total of 82 patients. In a prospective randomized study, 20 of these patients received pentazocine and 20 were treated with Fentanyl. The bolus quantity for pentazocine was 15 mg in 5 ml NaCl, and that for Fentanyl 0.05 mg in 5 ml NaCl. A maximum of 3 boluses was allowed within 1 h; the refractory period was 5 min. Both drugs were equally suited for the treatment of pain. With pentazocine, an average of 144 micrograms kg-1 min-1 was administered during the first 16 h after the operation; with Fentanyl, the quantity taken was 0.78 microgram kg-1 min-1. The inter- and intraindividual variance in the consumption of analgesics described by other authors was confirmed. The amount of analgesics required ranged between 0.05 and 1.95 mg for Fentanyl and between 15 and 435 mg for pentazocine in a period of 16 h. Three patients did not request an analgesic at all. The average consumption of analgesics constantly decreased in the first few postoperative hours, from 0.28 mg every 4 h after the operation to 0.18 mg every 4 h 16 h later (Fentanyl) and from 55 mg every 4 h after the operation to 31.5 mg every 4 h 16 h later (pentazocine). The majority of patients reported very positive experience with PCA. There were few side effects. Problems arose from the negative attitude of other doctors and the nursing staff, and from some misunderstandings.(ABSTRACT TRUNCATED AT 250 WORDS)

[Supraclavicular puncture of the anonymous vein]. / Die supraklavikuläre Anonymapunktion.

The investigation concerns a series of percutaneous, supraclavicular punctures and catheterisations of the anonymous veins conducted in the course of 8 years. 9042 patients were involved. The specific advantages of the anonymous vein puncture and catheterisation pertain to the easy accessibility of the vessel in all circulatory conditions and to the reduced risk of complications (rate of pneumothorax only 0.2%).

[On-demand analgesia with tramadol in bilateral multiple rib fractures]. / On-Demand-Analgesie mit Tramadol bei doppelseitiger Rippenserienfraktur.

A 41-year-old woman sustained bilaterally multiple rib fractures in a severe car accident. She developed severe pain-related dyspnoea. On-demand analgesia with tramadol (by pressing a button the patient could self-administer single doses of 20 mg) rapidly decreased the pain and respiration became almost normal. Daily doses of about 400 mg were sufficient. The ability to self-administer the analgesic clearly was an important psychological factor in the good response to the usually relatively weakly effective opioid.

[The anxiety process under various high doses of thalamonal for premedication]. / Der Angstprozess unter verschieden hohen Thalamonaldosen zur Prämedikation.

In this study special attention was paid to the individual anxiety--and coping process. 101 patients in a general hospital were premedicated with Innovar in different high dosages with and without Atropine. The four Innovar-groups were referred to a Dolantin/Atosilgroup. The results show that during the preoperative period the intensity of anxiety did not depend on premedication alone. Premedication was effective in reducing anxiety only in those patients who were aware of their somatic excitation at least to a certain degree. The preoperative anxiety process was also influenced by factors, like negative experience with anaesthesia and premedication, a negative attitude towards any kind of sedative and specific intrapsychic coping styles.