[Ultrasound-guided perivascular axillary brachial plexus block. A simple, effective and efficient procedure]. / Ultraschallgesteuerte perivaskuläre axilläre Plexusanästhesie. Eine einfache, effektive und effiziente Methode.

BACKGROUND: The perivascular axillary plexus block is an easily applicable procedure with a low risk of complications but with a high failure rate. To improve this, the standard procedure was combined with transpectoral sonography to benefit from the advantages of ultrasound, while using a nearly unchanged puncture technique. METHOD: The technique developed by the authors is described in this article and the success rate and the time factor were determined in a sample of 86 patients. The success rates were compared to previous rates without ultrasound and to those in the literature. RESULTS AND CONCLUSIONS: The rate of complete blocks without the use of transpectoral sonography in our clinic and in the literature was approximately 72%, whereas using transpectoral ultrasound it was 96.5%. None of the 86 patients with transpectoral sonography required general anaesthesia. The onset time using transpectoral sonography was approximately 6 min. The perivascular axillary plexus block, combined with transpectoral sonography, is an effective and efficient procedure.

[HME filter versus patient-related replacement of tubes from the ventilation circuit for anaesthesia: a cost-benefit analysis]. / HME-Filter versus patientenbezogener Wechsel der Beatmungsschlauchsysteme von Narkosegeräten: Eine Kosten-Nutzen-Analyse.

Procedure-related costs were calculated for an operating theatre with 10 operating rooms. The variable parameter was the different hygiene regimens for the preparation of the anaesthesia circuit. In April 2003 a change was made for the whole anaesthesia area. Either change of the anaesthesia tube system after every patient or the use of a hydrophobic HME-F (heat and moisture exchange filter) with daily or weekly change of the anaesthesia tube system were calculated. All costs were ascertained on real findings and typical procedures. Data according to safety and hygienic value were discussed and supplemented by our own findings about perioperative pneumonia. The additional costs for the HME-F are covered by the savings for CO(2) lines and the reduction of reprocessing expenses and overall material costs were reduced. The operational work on anaesthesia machines decreased considerably. Combined cost types revealed savings up to 9,72 EUR for a single anaesthesia procedure. Filtration of the respiratory gases for particles, bacteria, viruses and airway climatisation is an additional positive effect of HME-F use. Incidence of postoperative pneumonia on intensive care units was monitored by KISS (German hospital infection surveillance system) and the change to the HME-F regimen did not indicate a higher risk of infection. By the implementation of a weekly change of the anaesthesia tube system using HME filters a hygienic management for anaesthesia circuit reprocessing was found which could mobilize considerable resources.

Clinical evaluation of contrast-enhanced color Doppler sonography in the differential diagnosis of liver tumors.

PURPOSE: We investigated the value of contrast-enhanced color Doppler sonography in the differential diagnosis of liver tumors. METHODS: We prospectively examined 105 focal liver lesions in 100 patients by real-time gray-scale sonography, color Doppler sonography, and contrast-enhanced color Doppler sonography with galactose-based microbubbles (SH U 508A; Levovist). The final diagnoses of the liver lesions as confirmed by pathology or additional imaging techniques were 31 metastases, 25 hemangiomas, 19 hepatocellular carcinomas, 19 focal nodular hyperplasias, 2 cholangiocellular carcinomas, and 9 other lesions. RESULTS: Vascularity could be detected in 43 (41%) of the 105 lesions by conventional color Doppler sonography compared to 67 (64%) by contrast-enhanced color Doppler sonography. Contrast-enhanced color Doppler sonography identified moderate or extensive vascularity in all 19 focal nodular hyperplasias, moderate or extensive vascularity in 16 hepatocellular carcinomas and both cholangiocellular carcinomas, and no or minor vascularity in all but 3 hemangioma. The combination of gray-scale, conventional color Doppler, and contrast-enhanced color Doppler sonography led to the correct diagnosis in 81% of cases (85 of 105), compared to 57% (60/105) for gray-scale and conventional color Doppler sonography and 31% (33/105) for gray-scale sonography alone. CONCLUSIONS: Contrast-enhanced color Doppler sonography improves the detection of tumor vascularity and is useful in the differential diagnosis of liver lesions.