[Local anesthesia in ophthalmic surgery]. / Lokalanästhesie in der Ophthalmochirurgie.

In recent years anesthesia modalities have changed in ophthalmic surgery. A growing trend toward the use of topical anesthesia in cataract surgery is apparent. The present-day techniques used in ophthalmic surgery are retrobulbar anesthesia, peribulbar anesthesia, subtenon anesthesia, and subconjunctival anesthesia as injection techniques, topical anesthesia using drops, gel, or sponge, and intracameral anesthesia. Injectable anesthesia (RBA, PBA, STA) provides a higher level of analgesia and globe akinesia. With injection techniques the risks of vis a tergo and anesthetic complications increase; the level of analgesia after topical anesthesia could be improved by supplementation with i.v. narcotics.

Liquorpheresis (CSF-filtration): an effective treatment in acute and chronic severe autoimmune polyradiculoneuritis (Guillain-Barré syndrome).

In recent years, plasmapheresis has become a well established treatment of acute and chronic polyradiculoneuritis (Guillain-Barré syndrome, GBS). Nevertheless, there are still non-responders and there are particular risks associated with this treatment. Despite all efforts, the duration of severe forms of Guillain-Barré syndrome is still considerable. Inflammation and demyelination start intrathecally. We therefore used liquorpheresis (cerebrospinal fluid filtration) as a new effective therapeutic approach. Our first patient, severely disabled with acute GBS, artificially ventilated, had undergone plasma exchange without effect. Plasma immunoadsorption led only to transient improvement. After several liquorphereses, the patient recovered completely. In three additional patients with acute and two with chronic GBS an improvement of clinical signs in close temporal relation to liquorpheresis was observed. Twice, liquorpheresis was combined with immunoadsorption of cerebrospinal fluid. Liquorpheresis was well tolerated in all cases. This procedure may be effective by eliminating humoral or cell-bound factors responsible for the onset or/and maintenance of inflammation. Further controlled studies are necessary and are in progress.

[Experiences with autologous donation and transfusion equipment]. / Verfahren zur apparativen autologen Spende und Transfusion.

For autologous plasma predeposit there are commonly two types of cell-separators in use: 1. Discontinuous centrifugation (Plasma Collection System PCS, Haemonetics Company). 2. Discontinuous membrane filtration (Plasmapur-Monitor, Organon Teknika Company). Normally donation volume is 900 ml. The rate of undesired secondary effects does not exceed those numbers known of regular homologous donors. Shed wound blood processing by a wash-centrifuge cell separator (Type Cell-Saver, Haemonetics Company) stands for optimal quality of the refusable red blood cells. Depending on the type of operation and the accuracy of wound blood suction, up to 75% of the red blood cells lost may be harvested. In order to achieve more widespread mechanical autotransfusion, one issue is to lower the rather high costs of the disposables by simplifying the too highly sophisticated systems. From clinical experience with orthopedic patients, at least practical advice is given on how to use the single autologous transfusion methods in a comprehensive strategy.

[Kinetics of bacterial wash-out in the Haemonetics Cell Saver III]. / Kinetik der Bakterienauswaschung im Cell-Saver III Haemonetics.

Autologous, outdated blood units were inoculated with four types of bacteria--Pseudomonas aeruginosa, Escherichia coli, Streptococcus faecalis, Staphylococcus aureus--in two concentrations (10e4, 10e6) to test the effect of the washing procedure (Cell Saver III Haemonetics) on the elimination of bacteria. The elimination rate ranged from 17% (Streptococcus faec. 10e4) to 96% (Pseudomonas aer. 10e6). These results confirm the routine use of wash centrifuge systems (type Cell Saver) to process shed wound blood as well as drainage blood for autologous transfusions.

[4 years experience with the Ulm autologous transfusion concept]. / Vier Jahre Erfahrung mit dem autologen Transfusionskonzept Ulm (ATU).

After a 4-year period in clinical practice the autologous transfusion concept Ulm (ATU) has proved its value. The effort and expense involved are entirely justified by obvious medical advantages. The patients' active involvement in the therapeutic procedure is a remarkable aspect of positive motivation. Furthermore, the medical staff is positively motivated, too, in spite of the obvious additional load to their daily routine work.

[Differentiated blood replacement therapy in endoprosthesis surgery of the hip joint]. / Differenzierte Blutersatztherapie bei Endoprothese-Operationen des Hüftgelenks.

In a prospective clinical study with 37 patients (41-84 years) undergoing a first implantation of hip joint endoprothesis, a total blood loss of two liters in average was registrated including the first 24 h postoperative wound drainage blood. Sufficient volume replacement was achieved without any homologous blood components by consequently using a comprehensive concept of autologous transfusion including acute preoperative hemodilution, intra and postoperative blood salvage and preoperative plasma predeposit (ATU = Autologous Transfusion-Concept of Ulm). Plasma and blood substitution was managed mainly by polygelin and autologous fresh frozen plasma completed by autologous warm blood and processed autologous washed packed red cells. Through this any organization troubles or disadvantages of whole blood predeposit may be avoided. To increase the net gain of washed packed red cells time limited use of blood salvage disposables should be extended.

[Preoperative plasmapheresis]. / Präoperative Plasmapherese.

Plasmapheresis is performed during the preoperative patient preparation phase of the Ulm Autologous Transfusion Concept (ATU). On an outpatient basis, weeks or months before the operation, 900 ml autologous plasma is donated per visit using the one needle technique, shock frozen, and stored at -30 degrees C or lower. During a period of approximately 1 1/4 years, 813 patients were studied in order to obtain information (in addition to the observation of the usual vital statistics) concerning the effect of plasmapheresis on homeostasis and coagulation factors directly before, directly after, 2 h after, and 24 h after (in-patients only). A complete electrolyte solution of the Ringer-lactate type was used as volume substitution (1000 ml or 1500 ml). Arterial blood pressure and heart rate showed no significant change. The transient decrease in various laboratory parameters was within tolerable limits. The parameters for blood protein, anti-thrombin III, and immunoglobulin G had already normalized within 24 h. Our more than three year experience with more than 2600 patients and the collective data indicate no reason not to perform plasmapheresis on non-fasting outpatient patients. The for the most part postoperatively transfused autologous fresh frozen plasma represents an ideal, long acting volume substitution which contains such blood components as antithrombin III, immunoglobulins, and factor XIII. These blood components could be a contributing factor for a decreased danger of thrombosis, embolie, and infection, as well as provide for better wound healing.

[Catheter peridural anesthesia with bupivacaine HCI and bupivacaine CO2. A comparison and the effects of premedication]. / Katheterperiduralanaesthesie mit Bupivacain HCI und Bupivacain CO2. Vergleichende Untersuchung und Auswirkung der Prämedikation.

A controlled prospective randomized study was carried out to compare the action of 0.5% bupivacaine-CO2 and 0.5% bupivacaine-HCI both with and without diazepam premedication. Those patients given an epidural with 0.5% bupivacaine-CO2 and diazepam premedication showed both the briefest time to onset of action and the greatest degree of motor block. In contrast to the other three groups, none of these patients had missed segments. Despite the fact that no significant differences could be calculated, the difference in intensity of action observed in this investigation may well be of clinical relevance.