[Avoiding hypoxemia during anesthesia]. / Die Vermeidung der Hypoxämie während der Narkose.

The incidence of unexpected hypoxaemia during general anaesthesia was studied in 230 healthy patients undergoing a peripheral surgical procedure. Measurements of arterial oxygen and carbon dioxide tension (paO2 and paCO2) were performed under rigorously controlled conditions in regard to the age of the patients, their smoking habits, course and type of the anaesthetic and surgery, body position, inspiratory fraction of oxygen (FiO2), expiratory fraction of carbon dioxide (FECO2), respiratory minute volume and inspiratory to expiratory time ratio. 10% of the patients receiving FiO2 of 0.33 and 3.3% of those receiving 0.40 were found to have a paO2 below 80 mm Hg. 25% respect. 0% of older (greater than 60) and 6.7% respect. 4.4% of younger patients (less than 60 years) receiving FiO2 of 0.33 respect. 0.40 were hypoxemic (paO2 less than 80 mm Hg). These figures were compared with the results of an inquiry of practicing anaesthesiologists (in USA, West Germany and Switzerland) and their opinions about the safe FiO2 and paO2 limits. Most of the respondents use under the described conditions of this study an FiO2 of 0.33. At the same time 96% of them expect a paO2 over 80 mm Hg. On the basis of 10% incidence of hypoxaemic values among the patients studied it was concluded that FiO2 of 0.33 can not be considered as safe: increasing FiO2 to 0.40 helps to decrease the incidence of unexpected hypoxaemia especially in the patients over 40 years old.

[Fatal lung embolism following ischemia and peridural anesthesia]. / Tödliche Lungenembolie nach Blutleere und Periduralanaesthesie.

We report the case of a patient who died immediately following repair of a malleolar fracture. Post-mortem examination showed massive central and peripheral pulmonary artery thromboembolism. The possible causative role of peridural anaesthesia and/or ischaemic tourniquet technique are discussed. It is speculated that the combination of both techniques, but especially the last one, might be the provocative factor for such embolism in predisposed patients.

[Phantom phenomena during regional anesthesia]. / Phantom-Erscheinungen während regionaler Anaesthesie.

Phantom phenomena were studied following the administration of peridural (PDA), spinal (SA) and brachial plexus anaesthesia (PB) to 200 patients undergoing a peripheral surgical procedure. 18% of the subjects in PDA, 40% in SA and 63% in the PB group reported a typical, phantom of lower, respect. upper extremities as already described in the literature. Various additional (atypical) forms of phantoms were observed: 10% in PDA, 24% in SA and 6% in PB group. Sex, age, tourniquet, premedication and type of local anaesthetic did not influence substantially the occurrence of phantom. The latter was however directly related to the total dose (mg) of local anaesthetic administered. The appearance of phantom was not always a guarantee of successful block. The possible mechanisms of painless phantoms are discussed.

[Peridural morphine in the treatment of postoperative pain (author's transl)]. / Die peridurale Morphingabe zur Behandlung postoperativer Schmerzen.

The action of peridural morphine (1.5, 3.0 and 5.0 mg) as compared to placebo was studied in the patients who underwent inguinal hernia repair or lower extremity surgery under peridural anaesthesia. Morphine produced a dose-dependent intensive and long lasting segmental analgesia which was statistically significantly superior to placebo at all dosages. This action was however accompanied by a high incidence of urine retention and vomiting. We did not find any respiratory or circulatory depression. Nevertheless, it is accentuated that under different clinical conditions this depression might be highly probable.

[The luxation of the heart following a blunt trauma to the thorax. A case report (author's transl)]. / Herzluxation nach stumpfem Thoraxtrauma. Ein Fallbericht.

We report a rare complication in a patient who suffered blunt trauma to the thorax. During suturing of the ruptured aorta, distal to the subclavian artery, cardiac arrest occurred. For half an hour the pupils remained fixed and dilated, despite intensive reanimation efforts. It was then realised, that the heart had been displaced through a pericardial defect. Following its reposition the patient recovered without any signs of cerebral damage.