[Break of radial artery catheter resulting in a loose intra-arterial fragment]. / Knaek af arteria radialis-kateter med løst fragment intraarterielt.

An unusual complication after radial artery cannulation is described. Due to difficult fixation the distal part of the catheter broke loose, and was captured intravascularly. This complication has only been reported once before. The present case did not lead to surgical intervention. A suggestion is made as to, how to avoid this complication.

[Percutaneous dilatation tracheostomy at an intensive care unit]. / Perkutan dilatationstrakeostomi på intensiv afdeling.

Fourty-five cases of percutaneous dilatational tracheostomy (PDT) performed in the intensive care unit, Kolding Hospital, are reported in a retrospective study. All patients (mean age 60.8 years) had been on a ventilator due to critical diseases and had been subjected to translaryngeal intubation for an average of 6.1 days (range 1-12). PDT was uncomplicated in 41 cases (91%). Early bleeding, which required minor intervention, was described in three cases (7%). There was one case (2%) of minor bleeding seven days after PDT during haemodialysis. There had been no procedure-related death, and no life-threatening complications such as pneumothorax, paratracheal tube position or bleeding requiring transfusion were seen. Nineteen patients (42%) died due to progression of their underlying diseases with the tracheostomy functioning well, the mean cannulation time being 23.3 days. Twenty-six patients (58%) lived to decannulation with a mean length of cannulation of 13.7 days. The PDT procedure has the advantage of being bedside, thus avoiding transportation of a critically ill patient to the operating theatre.

[Anesthesiological aspects of laparoscopy in gynecological surgery]. / Anaestesiologiske aspekter ved laparoskopi til gynaekologiske indgreb.

A review of anaesthesia for gynaecologic laparoscopic surgery is given. Special criteria are needed for selection of patients, choice of anaesthesia and intraoperative monitoring. The cardiovascular and respiratory system are affected by tension from the pneumoperitoneum, absorption of CO2 and Trendelenburg position. Gas insufflation can provoke venous gas embolism, pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema. The introduction of laparoscopic instruments may result in unintentional injuries to intra-abdominal organs. The possibility that the procedure may have to be converted to open laparotomy needs to be considered. Bowel burns may result in perforation, peritonitis and sepsis. Laparoscopy is contraindicated in patients with serious cardiac disease, extensive bowel adhesions or intestinal obstruction. General anaesthesia with muscle paralysis, tracheal intubation and controlled ventilation is the preferred technique in these cases. Short acting anaesthetics are preferred in day case laparoscopy. Central neural blockade or infiltration anaesthesia supplemented with sedation and analgetics can be used for short laparoscopic procedures. The electrocardiogram, noninvasive arterial pressure monitor, airway pressure monitor, intra-abdominal pressure monitor, pulse oximeter and CO2 monitor are used routinely. Antiemetics and analgetics may be needed postoperatively.

[Non-traumatic dissection of the thoracic aorta. A review with special emphasis on postoperative paraplegia]. / Ikketraumatisk torakal aortadissektion. En oversigt med soerlig voegt på postoperativ paraplegi.

Non-traumatic dissection of the thoracic aorta is a degenerative vascular disease with a high morbidity and mortality. The main symptom is stabbing thoracic pain, but the diagnosis is made difficult when the clinical picture is dominated by symptoms caused by the aorta's neighbouring structures. The definitive diagnosis is made by aortography. Treatment and prognosis depend on the anatomic placement of the dissection. In dissection of the ascending aorta (type A) the treatment is solely surgical, whereas a combined medical and surgical treatment is recommended for dissections of the descending aorta (type B). The most common postoperative complication in type B dissection is paraplegia, which occurs in up to 40% of cases. The cause of paraplegia is postoperative ischaemia of the spinal medulla. Many methods and treatments have been used to avoid medullary ischaemic damage. The most important ones are reducing the time length of aortic clamping, maintaining an adequate perfusion pressure, and the use of moderate hypothermia. Spinal drainage with or without pharmacological intervention possibly has a preventive effect, but convincing clinical documentation is lacking.

Perioperative analgesia by 3-in-one block in total hip arthroplasty. Prospective randomized blind study.

In a prospective randomized blind study of 182 patients undergoing total hip arthroplasty, the patients per- and postoperative need for analgesics was assessed in two groups, one receiving general anesthesia and a 3-in-one block, the other group only general anesthesia. Although we found a significant reduction in analgesics per- and postoperatively in the 3-in-one block group, the difference in analgesics was small and has no clinical relevance in the patient with a healthy cardiovascular status. We conclude that 3-in-one block in combination with light general anesthesia is not the anesthetic of choice in total hip arthroplasty using the posterior approach.

Intramedullary plugs in total hip arthroplasty. A comparative study.

The quality of cement packing was radiographically evaluated using three different types of intramedullary plugs in 77 total hip arthroplasties. The Thackray polyethylene plug (38 mm, disc-shaped), with its large and flexible diameter, was best able to seal the femoral canal and produced significantly better cement packing compared to both the autologous bone plug and the Richard polyethylene plug (18.5 mm, bullet-shaped).

[Intra-atrial ECG via a central venous catheter]. / Intra-atrialt ekg via centralt venekateter.

The authors registered measurements of ECG via the saline column in a central venous catheter in a prospective investigation. The P-waves in the atrial ECG from various heights in the atrium and low down in the superior vena cava were compared with lead II in surface ECG and this revealed significantly larger P-waves in the invasive ECG. In patients with tachyarrhythmia, who have or require a central venous catheter, the atrial ECG will thus present an alternative to the oesophageal ECG in the diagnostic elucidation. The method is found to be easy to carry out and it is without risks or discomfort for the patient and it provides good information about atrial activity.

[Automated inflation and regulation of the pressure in infusion cuffs]. / Automatiseret oppustning og regulering af trykket i infusionsmanchetter.

Construction of a pressure regulator with connected tube and reservoir system for use in rapid intravenous infusion is described. This system is easy to construct, easy to employ and suitable for rapid correction of severe hypovolumaemia.

A case of accessory calcaneus.

A 5-year-old boy had accessory calcaneus (os trochleare) with pain, shoe pressure, and a varus position of the foot not reported previously. He became free from his symptoms after the abnormal bone had been excised.