Use of the post-tetanic train-of-four for evaluation of intense neuromuscular blockade with atracurium.
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Adolescent↗
Biomedical subjects
M Jöhr
Publications and source records attributed to M Jöhr.
[Continuous spinal anesthesia using bupivacaine. Report of experiences].
Continuous spinal anesthesia has not yet found general acceptance, although it is a simple and efficient method. Its main advantage is allowing a reliable block to be built up step by step while carefully monitoring the cardiovascular changes. Postspinal headache can be avoided by restricting the use of elderly patients. At our institution, continuous spinal anesthesia has been administered to geriatric high-risk patients for more than 6 years. We report our experience from the year 1986. PATIENTS AND METHODS. Over a 1-year period continuous spinal anesthesia was used for 157 patients with a mean age of 80.4 years (Fig. 1). Of these patients 111 (70.7%) were classified as ASA 3-5 (Fig. 2). In 2 cases a myocardial infarction dated back only 4 and 11 days. The most common indications for surgery were hip fractures (97, 61.8%) and vascular occlusions (37, 23.6%). An 18G Tuohy needle was used for lumbar puncture. The catheter (Portex minipack) was advanced 3-6 cm into the subarachnoid space. Plain bupivacaine 0.5% was injected in small increments until the desired block level was achieved. The catheters were removed immediately after surgery. RESULTS. In 155 of 157 cases surgery was completed under regional anesthesia. Two patients had to be intubated intraoperatively (1 unexpected laparatomy during vascular surgery, 1 with insufficient block for lumbar sympathectomy). The main technical problem was impossibility to advance the catheter into the subarachnoid space despite free flow of CSF (5 cases). For these patients single-shot spinal (4 cases) or epidural anesthesia (1 case) was used.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[A complication of continuous blockade of the femoral nerve].
The continuous femoral nerve block is an effective method of analgesia after knee surgery. We report a case with acute compression syndrome of the femoral nerve caused by a subfascial hematoma. The symptoms developed 30 h after induction of the block. Immediate decompression brought pain relief and prevented permanent neurologic sequelae.
Adult↗
Cardiomyopathy in cystic fibrosis: lymphoedema of the heart with focal myocardial fibrosis.
Cardiomyopathy in cystic fibrosis (CF) is an unusual heart disease, mainly characterized by a multifocal fibrosis of the left ventricle. The disorder chiefly occurs in the age group of 1-2 years and leads to fatal cardiac failure. The causal pathogenesis of the disease has not been discovered up to now. In two cases of CF-associated cardiomyopathy we found an oedema (mainly lymphoedema) of the myo- and epicardium and a lymph stasis in lymph vessels and lymph nodes of the heart. Based on a comparative study using animal models we speculate that a) CF may be complicated by a disorder of cardiac lymph circulation, and b) chronic cardiac lymphoedema of the heart in CF can cause focal myocardial damage with fibrosis.
Cardiomegaly↗
Generating a learning curve for pediatric caudal epidural blocks: an empirical evaluation of technical skills in novice and experienced anesthetists.
BACKGROUND AND OBJECTIVES: Learning curves for anesthesia procedures in adult patients have been determined, but no data are available on procedures in pediatric anesthesia. The aim of this study was to assess the number of caudal blocks needed to guarantee a high success rate in performing caudal epidural analgesia in children. METHODS: At a teaching hospital, the technical skills of 7 residents in anesthesiology who performed caudal blocks were evaluated during 4 months using a standardized self-evaluation questionnaire. At the start of the study period, the residents had no prior experience in pediatric anesthesia or in performing caudal epidural blocks. All residents entered the pediatric rotation after a minimum of 1 year of training in adult general and regional anesthesia. The blocks were rated using a binary score. For comparison, the success rates of 8 experienced staff anesthesiologists were collected during the same period using the same self-evaluation questionnaire. Statistical analyses were performed by generating individual and institutional learning curves using the pooled data. The learning curves were calculated with the aid of a least-square fit model and 95% confidence intervals were estimated by a Monte Carlo procedure with a bootstrap technique. RESULTS: The success rate of residents was 80% after 32 procedures (95% confidence interval of 0.59 to 1.00). The pooled success rate of the staff anesthesiologists was 0.73 (mean) with a standard deviation of 0.45, which was not statistically different from the success rate of the residents. CONCLUSION: High success rates in performing caudal anesthesia in pediatric patients can be acquired after a limited number of cases. Success rates of residents learning this procedure are comparable to the results of staff anesthesiologists.
Anesthesia, Caudal↗