[Conservative treatment of brain edema--which way is leading to Rome?]. / Konservative Therapie bei Hirnödem--welche Wege führen nach Rom?

In patients with brain edema the pathophysiology of the different forms of edema have to be considered to ensure the prompt, sensible and consistent use of the limited treatment modalities available. Brain edema may be classified into cytotoxic and vasogenic edema, these two types often coexist in one patient. Head elevation, hyperventilation, osmotic therapy and reduction of brain metabolism by sedation or hypothermia should be used closely monitoring ICP and blood pressure. In the future considering the autoregulatory capacity of the individual patient will possibly lead to a more effective action of the treatment modalities described. Further research will open new perspectives how aquaporines are involved in the genesis and mobilisation of brain edema.

[Intubation and ventilation during thoracic surgery in children]. / Thoraxchirurgie bei Kindern--Intubation und Beatmung: die Ein-Lungen-Ventilation.

Single lung ventilation is indicated in many cases for thoracic surgery in children. The indication for single lung ventilation and the airway management should always be discussed thoroughly with the surgeon in order to tailor the effort, complexity and risk of airway management to the needs of the patient. According to the height and age of the child endobronchial intubation, bronchial blockers, the Univent-tube and double lumen tubes can be used. During single lung ventilation infants are particularly predisposed to hypoxemia, because unlike adults in the lateral decubitus position the dependent ventilated lung is prone to alveolar collapse and does not receive a larger part of pulmonary perfusion than the non ventilated lung.

Feasibility of radical perineal prostatectomy under spinal anaesthesia.

OBJECTIVE: To evaluate the possibility of a perineal radical prostatectomy (PRP) under spinal anaesthesia, as although it is usually done under general anaesthesia, there is currently a need to minimize costs and morbidity. PATIENTS AND METHODS: Between January and December 2003, there were 337 PRPs at our institution, of which 47 were on patients under combined spinal/epidural (CSE) anaesthesia administered via a standard L3/4 or L4/5 approach. We analysed the feasibility of PRP under CSE and evaluated perioperative morbidity, including blood loss and hospital stay. RESULTS: All 47 procedures were done under CSE with no need for conversion to general anaesthesia. The mean (range) duration of PRP was 56 (43-112) min, the mean blood loss 270 mL, and the transurethral catheter was removed at 7 days in 40 and at 14 days in the remaining seven patients. There were no complications during surgery, e.g. rectal or ureteric lesions. The mean hospital stay was 8.2 days. CONCLUSION: PRP is safe under CSE anaesthesia; this may be helpful in minimizing morbidity and medical costs, as well as providing an alternative in patients in whom general anaesthesia is not recommended.