[Control of the position of central venous catheters by intracardial ECG. A presentation of the method and its advantages compared to roentgen control]. / Lagekontrolle zentralvenöser Katheter mit dem intrakardialen EKG. Eine Darstellung der Methode und ihrer Vorzüge gegenüber der Röntgen-Kontrolle.

It is obligatory to control the localization of a central venous catheter. We describe a simple own method for controlling the correct position of a central venous catheter electrocardiographically. The reported method is accurate and inexpensive.

[Anaphylactic shock during general anaesthesia due to fentanyl and alloferin in a patient with positive skin test (author's transl)]. / Anaphylaktischer Schock während der Narkose mit positivem Hauttest auf Fentanyl und Alloferin.

A patient who suffered an anaphylactic shock during general anaesthesia showed positive reactions in a skin test with fentanyl (i.e. in Thalamonal) and Alloferin. As we did not find similar case reports in literature we present this rare case of anaphylactic shock during general anaesthesia evidently based on allergic mechanisms induced by fentanyl and Alloferin.

[Change of intracranial pressure in neurosurgical patients by hyperventilation, positive negative pressure ventilation and PEEP (author's transl)]. / Beeinflussung des intracraniellen Druckes bei neurochirurgischen Operationen durch Hyperventilation, positiv-negative Druckbeatmung und PEEP.

The effects of a hyperventilation, positive negative pressure ventilation (PNPV) and ventilation using positive endexpiratory pressure (PEEP), on intracranial pressure (ICP) was measured in 24 patients suffering from different neurosurgical disorders. The patients were given a basic anaesthesia including muscle relaxation. The investigations showed, that hyperventilation, followed by a PCO2 of 26 and 30 torr, clearly lowered the intracranial pressure. The pressure drop was much more pronounced when the preexisting ICP was high than when it was low, due to the form of the compliance curve of the brain. PNPV also lowered intracranial pressure, but a harmful effect of this technique on lung function and structure is known. Its use is justified only for short periods and in addition to other measures for lowering ICP. The results also demonstrated that PNPV possesses limited beneficial properties with regard to the subject discussed here. Ventilation by PEEP significantly increased ICP. This technique is to be employed with caution in neurosurgery. Arterial pressure (radial artery) and central venous pressure (subclavian vein) were also recorded.

[Comparative investigations on the influence of etomidate, thiopentone and methohexitone on the intracranial pressure of the patient (author's transl)]. / Vergleichende Untersuchungen über den Einfluss von Etomidate, Thiopental und Methohexital auf den intracraniellen Druck des Patienten.

Intracranial pressure was measured under the influence of the new hypnotic etomidate (Dosage: 0.15 to 0.30 mg/kg b.w.). For comparison thiopentone (Trapanal: 3 to 4.5 mg/kg) and methohexitone (Brevimytal: 1 to 1.5 mg/kg) were given. The investigations were performed on 28 neurosurgical patients, who thereafter underwent surgery. The patients already had a closed or open ventricular catheter by means of which intracranial pressure was continuously measured. Etomidate lowered intracranial pressure. This happened during induction of anaesthesia and later during neuroleptanalgesia when etomidate was again injected. The pressure fall after etomidate was similar to that seen after thiopentone. It was at the time of induction 5 and later on 3mm Hg. Methohexitone showed a somewhat smaller effect. The cerebral perfusion pressure was calculated. When etomidate was given during the course of a neuroleptanalgesia the cerebral perfusion pressure merely decreased slightly (-7 per cent). Perfusion pressure remained stable after thiopentone and methohexitone.

[Effect of enflurane (ethrane) on intracranial pressure in comparison with halothane (author's transl)]. / Die Wirkung von Enflurane (Ethrane) im Vergleich zu Halothan auf den intracraniellen Druck

Enflurane (Ethrane) was given before operation to 13 neurosurgical patients. 11 of them received halothane for comparison of effects on intracranial pressure (ventricular catheter), blood pressure and central venous pressure during controlled ventilation. Neuroleptanalgesia was used as basic anaesthesia. The results showed that enflurane, when initial pressure levels were between 0-20 mm Hg, had better properties with regard to intracranial pressure than halothane. The intracranial pressure of 6 patients under enflurane rose. Of the remaining patients pressure did not change or even fell. Under halothane, given in a comparable doses, there was always a marked increase of intracranial pressure. If intracranial pressure of one patient under enflurane rose, then the increase by halothane always was more pronounced. The results from 1 patient had to be excluded because of spontaneously occurring plateau waves. Blood pressure was lowered by both agents while central venous pressure remained unchanged.