The effects of electromyographic activity on the accuracy of the Narcotrend monitor compared with the Bispectral Index during combined anaesthesia.

The Narcotrend is a monitor system for the assessment of depth of anaesthesia. The objective of this trial was to investigate the susceptibility of the Narcotrend to electromyographic (EMG) activity when compared with the Bispectral Index (BIS). We enrolled 33 patients undergoing major urological procedures under combined anaesthesia (thoracic epidural analgesia and general anaesthesia). Anaesthetic depth was assessed simultaneously by the BIS XP and Narcotrend. The intended anaesthetic depth ranged between 40 and 55 in the BIS and between D2 and D0 in the Narcotrend. BIS, but not Narcotrend, values correlated significantly (p < 0.0001) with EMG. BIS values between 70 and 80 occurred intermittently above an EMG activity of 35 dB, whereas the Narcotrend and the clinical signs remained unchanged during the period of elevated BIS values. None of the patients reported intra-operative awareness. Increased electromyographic activity does not affect Narcotrend values. Under combined anaesthesia, the Narcotrend monitor is more reliable when compared with the BIS regarding susceptibility to increased EMG activity.

Our experience with carotid endarterectomy without patch and shunt.

The purpose of the present study was to assess the efficacy of endarterectomy without patch and shunt using a homogeneous group of patients. From January 1987 through December 1994, ninety-eight patients (70 males and 28 females) with mean age 67 years and unilateral atherosclerotic carotid stenosis underwent endarterectomy without the use of a shunt, patch, EEG, stump pressure measurements or other methods. The patients were preoperatively classified into three groups according to clinical symptoms. The overall neurologic morbidity consisted of 2 (2%) permanent and 3 (4%) temporary deficits. Based on our results we concluded that endarterectomy without a shunt is a simple, safe method in cases with no hemodynamically concomitant significant lesions. The neurological complications are probably due to embolization rather than temporary ischemia during operation.

[Valve of plastic repair of the deep femoral artery in chronic circulatory disease of the lower extremities]. / Die Bedeutung der Plastik der Arteria profunda femoris bei chronischen Durchblutungsstörungen der unteren Extremitäten

It is reported about indication, surgical technique, early and late postoperative results of the plastic of the profunda femoris artery. On 17, mainly old patients with chronic circulatory disease of the lower limbs was this operation carried out, because a longer angioplastic operative procedure would have been a great risk. The statement, that 47% of our patients were practically without symptoms after four years is promising for the plastic of the profunda femoris artery with chronic ischemia syndrome of the lower limbs.