[Difficult intubation and anesthesia in Pfaundler-Hurler disease]. / Erschwerte Intubation und Narkose bei Morbus Pfaundler Hurler.

Because of increasing dyspnea, adenoidectomy and tonsillectomy were indicated in a 6-year-old girl with Pfaundler-Hurler disease. The main symptoms were cardiac insufficiency and chronic bronchitis. Because of the large skull with hypoplastic cervical spine, anomalies of facial bones, larynx and jawbone normal intubation was impossible. We therefore performed intubation during spontaneous breathing under inhalation anesthesia and topical anesthesia of the larynx. After exploratory laryngoscopy a preformed Woodbridge tube was inserted into the trachea blind and by ear during of inspiration. The patient's cardiac insufficiency and chronic bronchitis made a balanced anesthesia with reduced dosage of rapifen and halothane necessary. In spite of the poor general prognosis, after the operation a considerable relief of the patient's suffering was noted, because she was able to breathe freely.

[Rate of contamination of intravenous indwelling cannulae with sideport access]. / Kontaminationsrate von Venenverweilkanülen mit Zuspritzpforte.

136 cannulae with valved side injection port were introduced intravenously into patients from the general surgery, urology and dermato-surgical service under clinical routine conditions. The cannulae were used from 1 up to 4 days for anaesthesia purposes as well as peri- and postoperative infusion therapy and injection of drugs through the sideport. After use the cannulae were removed following an aseptic procedure and examined microbiologically. 37 cannulae (27.2%) were found contaminated, 25 of these (18.3%) with more than 25 colonies. The infusion line (border of the conus, the interior of the conus and the lumen of the cannula) was 21 times (15.4%), the side injection port 6 times (4.4%) and the intravasal capillary surface 17 times (12.5%) contaminated. Contamination of the cannula or of parts of the cannula did not correlate well with observed signs of inflammation at the puncture site (45 patients = 33%). If, however, the contamination of the cannula is considered to be an infection risk, the addition of a side injection port to such a cannula does not increase the risk of infection. This risk is much greater via the infusion line.

[Effect of anesthesia and surgery on the postoperative course in multiple sclerosis]. / Einfluss von Narkose und Operation auf den postoperativen Verlauf der Multiplen Sklerose.

Multiple sclerosis is the most frequently occurring neurologic disease in our area. The common opinion is that a stress situation such as a surgical procedure or general anaesthesia may lead to an amelioration of this disease. No really convincing evidence exists to support this opinion. The observation of the postoperative course of two patients, who underwent a total of three surgical procedures under general anaesthesia suggests a short-lived temporary deterioration of their symptoms. An amelioration of the disease however was not observed.

[Mild form of malignant hyperthermia? OR, ABNORMAL REACTION To succinyldicholine?]. / Abortive Verlaufsform der malignen Hyperpyrexie? ODER Abnorme Reaktion auf Succinyldicholin?

In addition to two published cases of malignant hyperthermia (M.H.) 13 more cases have been observed in this institution since 1971, which are probably early reactions of the M.H. type. All 13 patients were children, 3-12 years of age, who developed a rigor of the jaw muscles after succinyldicholine and/or halothane within minutes after the induction of anesthesia. Further symptoms that could be observed regularly were a tachycardia of several hours duration and a marked elevation of the serum CPK-activity with a peak after 24 hours. Since the anesthesia was terminted immediately and the operations postponed as soon as a M.H. reaction was suspected, the rise in body temperature was minimal or absent and exceeded in no case 39 degrees C. Several children were operated upon later in neuroleptanalgesia (NLA) supplemented by nitrous oxide without any muscle relaxants. None of these children developed the aforementioned symptoms rigor, techycardia and CPK-elevation. One child had Alloferin in addition to NLA-nitrous oxide-anesthesia. This child had postoperatively a tachycardia lasting several hours and 24 hours later a serum CPK activity of 1500 U/1. Since this CPK activity is higher than in comparable cases (see fig. 1) it is concluded, that the nitrous oxide-NLA sequence appears to be safe for patients susceptible to M.H. Alloferin however must probably be regarded as a trigger agent for M.H.