Acta Anaesthesiologica ScandinavicaVolume 42, Issue s113 p. 21-23 Spinal anaesthesia for caesarean delivery L. IRESTEDT, Corresponding Author L. IRESTEDT Department of Anesthesiology and Intensive Care, Karolinska Hospital, Stockholm, SwedenDepartment of Anesthesiology and Intensive Care Karolinska Hospital SE-171 76 Stockholm, Sweden Fax +46 8 30 77 95Search for more papers by this author L. IRESTEDT, Corresponding Author L. IRESTEDT Department of Anesthesiology and Intensive Care, Karolinska Hospital, Stockholm, SwedenDepartment of Anesthesiology and Intensive Care Karolinska Hospital SE-171 76 Stockholm, Sweden Fax +46 8 30 77 95Search for more papers by this author First published: 30 December 2008 https://doi.org/10.1111/j.1399-6576.1998.tb04982.xCitations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Marx GF. The long road to the introduction of spinal blockade in obstetrics. Int J Obstet Anesth 1991; 1: 47–49. 2 Irestedt L, Lagercrantz H, Hjemdahl P, Hägnevik K, Belfrage P. Fetal and maternal plasma catecholamine levels at elective cesarean section under general or epidural anesthesia versus vaginal delivery. Am J Obstet Gynecol 1982; 142: 1004–1010. 3 Rout CC, Akoojee SS, Rocke DA, Gouws E. Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section. Brit J Anaesth 1992; 68: 394–397. 4 Rout CC, Rocke DA, Levin J, Gouws E, Reddy D. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section. Anesthesiology 1993; 79: 262–269. 5 Wennberg E, Frid I, Haljamäe H, Wennergren M, Kjellmer I. Comparison of Ringer's acetate with 3% dextran 70 for volume loading before extradural caesarean section. Brit J Anaesth 1990; 65: 654–660. 6 Karinen J, Räsänen J, Alahuhta S, Jouppila R, Jouppila P. Effect of crystalloid and colloid preloading on uteroplacental and maternal haemodynamic state during spinal anaesthesia for caesarean section. Brit J Anaesth 1995; 75: 531–535. 7 Olofsson Ch, Ekblom A, Sköldefors E, Wåglund B, Irestedt L. Anaesthetic quality during caesarean section following subarachnoid or epidural administration of bupivacaine with or without fentanyl. Acta Anaesthesiol Scand 1997; 41: 332–338. 8 Albright G. Editorial views. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51: 285–287. 9 Hägnevik K, Irestedt L, Lundell B, Sköldefors E. Cardiac function and sympathoadrenal activity in the newborn after caesarean section under spinal and epidural anaesthesia. Acta Anaesthesiol Scand 1988; 32: 234–238. 10 Davies SJ, Paech MJ, Welch H, Evans SF, Pavy TJG. Maternal experience during epidural or combined spinal–epidural anesthesia for cesarean section: A prospective, randomized trial. Anesth Analg 1997; 85: 607–613. 11 Alahuhta S, Kangas–Saarela T, Hollmèn AI, Edström HH. Visceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine. Acta Anaesthesiol Scand 1990; 34: 95–98. 12 Capogna G, Celleno D. Improving epidural anesthesia during cesarean section: causes of maternal discomfort or pain during surgery. Int J Obstet Anesth 1994; 3: 149–152. 13 Hirabayashi Y, Saitoh K, Fukuda H, Shimizu R. Visceral pain during caesarean section: effect of varying dose of spinal amethocaine. Brit J Anaesth 1995; 75: 266–268. 14 Irestedt L, Emanuelsson B–M, Ekblom A, Olofsson C, Re–ventlid H. Ropivacaine 7.5 mg/ml for elective caesarean section. A clinical and pharmacokinetic comparison of 150 mg and 187.5 mg. Acta Anaesthesiol Scand 1997; 41: 1149–1156. 15 Brown GW, Russell IF. A survey of anaesthesia for caesarean section. Int J Obstet Anesth 1995; 4: 214–218. 16 Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesiarelated deaths during obstetric delivery in the United States, 1979–1990. Anesthesiology 1997; 86: 277–284. Citing Literature Volume42, Issues113December 1998Pages 21-23 ReferencesRelatedInformation
BACKGROUND:Postdural puncture headache (PDPH) and backache are well known complications of spinal anaesthesia. The incidence of PDPH may be significant in young people (< 50 years). The present study was undertaken in order to compare the utility and complication rate of the Whitacre and Ouincke spinal needles. METHODS:During three years all patients who could comply, and who were to undergo spinal anaesthesia at the Department were asked to join this quality control study. Each one received a questionnaire including questions about discomfort and other possible side effects attributed to spinal anaesthesia. In each case, an extended anaesthetic record was filled out by the anaesthesiologist. About 50 anaesthesiologists at different educational levels were involved. RESULTS:The study includes 2598 cases, of which questionnaires were returned by 66%. Needles of the 25 G gauge size were used in over 90% of the cases. Multiple skin punctures were required more frequently in the Quincke than in the Whitacre group (P < 0.01). The number of insufficient blocks was also higher in the Quincke group (P < 0.01). There was a higher incidence of backache in the Quincke group (P < 0.05). In patients under 50 years, PDPH was more frequent following use of the Quincke needle (P < 0.05), whereas no difference between the needles in this regard was found among those over 50 years (P > 0.05). CONCLUSIONS:For routine clinical use the Whitacre needle appears to be associated with better performance and increased reliability. In younger patients the Whitacre needle have the additional advantage of decreasing the risk of postdural puncture headache.
Changes in body position alters the functional residual capacity (FRC). Most anesthetics reduce FRC in the recumbent but not sitting position. Inspired gas distribution in anesthesia-paralyzed subjects whose lungs are mechanically ventilated, is different from that in the awake state in all but the prone position. The function of the diaphragm is altered by postural changes. The pattern of motion of the diaphragm is different during mechanical ventilation than during spontaneous breathing. Also the end-expiratory shape is affected by induction of anesthesia, but this shape change contributes little to the reduction of FRC. The distribution of pulmonary blood flow is determined not only by gravity, but also by an intrinsic non-gravity dependent factor. These two factors can be additive in some positions but opposing in others.
To Torsten Gordh senior: I was asked to participate in this celebration day arranged because of your 90 years birthday and I am really glad to do so, in order to honor my father. In my lecture I will connect to Torsten Gordh senior's deep and well known interest for the spinal cord and anaesthesia/analgesia, and today discuss the role of nitric oxide (NO) in the spinal cord, and its importance for neuropathic pain and neurodegeneration.
Acta Anaesthesiologica ScandinavicaVolume 42, Issue s113 p. 31-33 Trends and targets for treatment of pain, a pharmaceutical industry perspective ANDERS HAEGERSTRAND MD, PhD, ANDERS HAEGERSTRAND MD, PhD Vice President Discovery Division, Astra Pain Control AB, Hälsovägen 7,141 57 Huddinge, SwedenSearch for more papers by this author ANDERS HAEGERSTRAND MD, PhD, ANDERS HAEGERSTRAND MD, PhD Vice President Discovery Division, Astra Pain Control AB, Hälsovägen 7,141 57 Huddinge, SwedenSearch for more papers by this author First published: 30 December 2008 https://doi.org/10.1111/j.1399-6576.1998.tb04985.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume42, Issues113December 1998Pages 31-33 RelatedInformation
Acta Anaesthesiologica ScandinavicaVolume 42, Issue s113 p. 34-38 How anaesthesiology came to Sweden TORSTEN GORDH Sr, MD, PhD, TORSTEN GORDH Sr, MD, PhD Professor emeritus Department of Anesthesia and Intensive Care, Karolinska Hospital and Institute, SE-171 76 Stockholm, SwedenSearch for more papers by this author TORSTEN GORDH Sr, MD, PhD, TORSTEN GORDH Sr, MD, PhD Professor emeritus Department of Anesthesia and Intensive Care, Karolinska Hospital and Institute, SE-171 76 Stockholm, SwedenSearch for more papers by this author First published: 30 December 2008 https://doi.org/10.1111/j.1399-6576.1998.tb04986.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 Gordh T. The development of anaesthesiology in Sweden. Acta Anaesthesiol Scand 1975; 19: 344–348. 2 Gordh T, Ralph M Waters and Swedish anesthesiology. J Clin Anesth 1994; 6: 221–226. 3 Gordh T. Narkos som specialitet och dess framtidsutsikter (In Swedish); Anaesthesia as a medical speciality and its future prospects. In: Meddelanden från Sveriges yngre läkares förening 1944, 17. 4 Gordh T. Xylocain – a new local analgesic. Anaesthesia 1949; 4: 4–21. 5 Frankson C, Gordh T. Headache after spinal anesthesia and a technique for lessening its frequency. Acta Chir Scand 1946; 94: 443–454. 6 Gordh T. A new simple and practical needle for intravenous anaesthesia. Anesthesiology 1945; 6(3): 258–260. 7 Nilsson E. On treatment of barbiturate poisoning. A modified clinical aspect. Acta Med Scand 1951: suppl 253. 8 Dardel O, Thesleff S. Succinylcholine iodide as a muscular relaxant. Acta Chir Scand 1952; 103: 321. 9 Gordh T. Postural circulatory and respiratory changes during ether and intravenous anesthesia. Acta Chir Scand 1945: suppl 102. Citing Literature Volume42, Issues113December 1998Pages 34-38 ReferencesRelatedInformation
Acta Anaesthesiologica ScandinavicaVolume 42, Issue s113 p. 24-28 Pain analysis in prediction of treatment outcome S. ARNÉR, S. ARNÉR Department of Anaesthesiology and Intensive Care, Karolinska Hospital, Stockholm, SwedenSearch for more papers by this author S. ARNÉR, S. ARNÉR Department of Anaesthesiology and Intensive Care, Karolinska Hospital, Stockholm, SwedenSearch for more papers by this author First published: 30 December 2008 https://doi.org/10.1111/j.1399-6576.1998.tb04983.xCitations: 14AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 Cancer pain relief World Health Organication Geneva 1996, 63 pp. 2 Treatment of long lasting pain. A comprehensive evaluation by the Swedish National Board of Health and Welfare. SoSreport 1994: 4 (in Swedish): 199. 3 Arnér S, Meyerson B. Lack of analgesic effects of opioids on neuropathic and idiopathic forms of pain. Pain 1988; 33: 1123. 4 Gustafsson LL, Eblind WF, Osaki E, Stanski DR, Shuter SL. Plasma concentration clamping in the rat using a computercontrolled infuson pump. Pharmaceutical Research 1992; 9: 800–807. 5 Meyerson BA. Pharmacological tests in pain analysis and prediction of treatment outcome. Pain 1997; 72: 1–3. 6 Yamamoto T, Katayama Y, Hiryama T, Tsubokawa. Pharmacological classification of central post–stroke pain: comparison with the results of chronic motor cortex stimulation therapy. Pain 1997; 72: 5–12. 7 Sörensen J, Aaro S, Bengtsson M, Caiman S, Reigo T, Tropp H. Can a pharmacological pain analysis in patients with chronic low back pain predict the outcome of lumbar fusion Eur Spine 1996; 5: 326–331. 8 Xu XS, Puke M, Verge VMK, Huges I, Hökfelt T. Upregulation of cholecystokinin in primary sensory neurons is associated with morphine insensity in experimental neurophatic pain in rats. Neurosc Lett 1993; 152: 129–132. 9 Sörensen J, Bengtsson A, Bäckman E, Henriksson KG, Bengtsson M. Pain analysis in patients with fibromyalgia. Effects of intravenous morphine, lidocaine and ketamine. Scand J of Reumatol 1995; 24: 360–365. 10 Stubhaug A, Breivik H, Eide PK, Kreunen M, Foss A. Mapping of punctuate hyperalgesia orund a surgical incision demonstrates that ketamine is a powerful supressor of central sensitization to pain following surgery. Acta Anaesth Scand 1997; 41: 1124–1132. 11 Arnér S, Arnér B. Differential effect of epidural morphine in the treatment of cancer related pain. Acta Anesth Scand 1985; 29: 32–36. 12 Olofsson Ch, Ekblom A, Ekman–Ordeberg G, Hjelm A, Irestedt L. Lack of analgesic effect of systemically administered morphine or pethidin on labour pain. Br J Obstet Gynaeacol 1996; 103: 968–972. 13 Eriksson–Mjöberg M, Svensson J–O, Almkvist O, Ölund A, Gustafsson LL. Epidural morphine gives better relief than patient controlled intravenous morphine after hysterectomy. British Journal of Anaesthesia 1997; 78: 10–16. 14 Lamotte C, Pert CB, Snyder SH. Opiate receptor binding in primate spinal cord. Brain Res 1976; 112: 407–412. 15 Arnér S, Meyerson BA. Opioids in neuropathic pain. Pain Digest 1993; 3: 15–22. 16 Arnér S, Ahlberg–Lind B. Information technology in Pain Clinic. Experiences from an inter–Scandinavian data base development. Abstract SASP annual meeting Aarhus, Denmark 1997. 17 Kupers RC, Konings H, Adiansen H, Gybels JM. Morphine differentially affects the sensory and affective pain ratings in neurogenic, idiopathic forms of pain. Pain 1991; 47: 5. 18 Hansson P. Neurogenic pain. Pain: Clinical updates 1994; ii: 1–4. 19 Hansson P. Possibilities of quantitative sensory analysis in pain patients. In: J Boivie, P Hansson, U Lindblom, eds. Touch temperature and pain in health and disease. Mechanisms and assessements. Seattle: LASP Press, 1994: 113–132. 20 Awerbuch GI, Sandy K. Mexiletine for thalamic pain syndrome. Intern J Neuroscience 1990; 55: 129–133. 21 Abram S, Yaksh T. Systemic lidocaine blocks nerve injuryinduced hyperalgesia and nociceptive–driven spinal sensitization in the rat. Anesthesiology 1994; 80: 383–391. 22 Tanelian D, Maclver B. Analgesic concentrations of lidocaine suppress tonic A–delta and C–fiberdischarges produced by acute injure. Anesthesiology 1991; 74: 934–936. 23 Jänig W, Stanton Hicks M. Reflex sympathetic dystrophy: a reappraisal. Progress in pain research and management. Seattle. LASP press, 1996: 217–237. 24 Torebjörk E, Wharen LK, Wallin G, Hallin R, Koltzenburg M. Noradrenalin–evoked pain in neuralgia. Pain 1995; 63: 11–20. 25 Bonica JJ. Causalgia and other reflex sympathetic dystrophies. In: JJ Bonica, (ed.). The management of pain, 2nd edn. Lea & Febiger, Philadelphia, 1990, pp 220–243. 26 Arnér S. Intravenous phentolamine test: diagnostic and prognostic use in reflex sympathetic dystrophy. Pain 1991; 46: 17–22. 27 Kinnman E, Nygårds EB, Hansson P. Peripheral a–adrenoreceptors are involved in the development of Capsaisininduced ongoing and stimoluse evoked pain in humans. Pain 1997; 69: 79–85. 28 Sjölund K–F, Sollevi A, Belfrage M, Lundeberg T. R–phenylisopropyl–adenosine reduces scratching behaviour in a mononeuropathic pain model in the rat. Neuroreport 1996; 7: 1856–1860. 29 Segerdahl M, Ekblom A, Sollevi A. Influence of adenosine, ketamine and morphine on experimentally induced ischemic pain in healthy volunteers. Anesth Analg 1994; 79: 787–791. 30 Belfrage M, Sollevi A, Segerdahl M, Sjölund K–F, Hansson P. Systemic adenosine infusion alleviates spontaneous and stimulus evoked pain in patients with peripheral neuropathic pain. Anesth Analg 1995; 81: 713–717. 31 Jian–Guo C, Sollevi A, Linderoth B, Meyerson BA. Adenosine receptor activation suppresses tactile hypersensitivity and potentiates spinal cord stumlation in mononeuropathic rats. Elsevier: Neuroscience letters 1997; 223: 173–176. 32 Dehl MC, Bertilsson L. Genetically variable metabolism of antidepressants and neuroleptic drugs in man. Pharmacogenetics 1993; 3: 61–70. Citing Literature Volume42, Issues113December 1998Pages 24-28 ReferencesRelatedInformation
Acta Anaesthesiologica ScandinavicaVolume 42, Issue s113 p. 1-2 A salute for Torsten Gordh, 90 Sfen Lindahl, Sfen LindahlSearch for more papers by this author Sfen Lindahl, Sfen LindahlSearch for more papers by this author First published: 30 December 2008 https://doi.org/10.1111/j.1399-6576.1998.tb04977.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume42, Issues113December 1998Pages 1-2 RelatedInformation
This paper was presented in September 1997 during a Round Table Discussion on lidocaine toxicity, held at the Nobel Forum, Karolinska Institute, Stockholm, Sweden. The occasion was in honor of Professor emeritus Torsten Gordh, who in August 1997 celebrated his 90th birthday. Torsten Gordh, also present at the Round Table Discussion, was the first anesthesiologist who used lidocaine clinically. Today, when some clinical problems with the intrathecal use of lidocaine are discussed, we are indeed fortunate to have Torsten Gordh still most vital and active in our midst.
Hans v. Euler, while investigating how genes and enzymes were chemically related in some chlorofylldefective mutants of barley, isolated gramme, an indole. Erdtman synthetized isogramine and found it to have weak anesthetic properties. He then together with Löfgren synthetized other amino‐amides, but no one of them could compete with the existing local anesthetics of the ester‐type, derivatives of para‐aminobenzoic acid, e.g. procaine. Later Löfgren and Lundqvist followed up these studies and found an amid compound lidocaine (2‐dimethylaminoacet2, 6‐xylidide). Lidocaine represented such a significant advance over procaine in clinical tests preformed by T. Gordh that it was introduced for clinical use. It has now during a half century been the standard local anesthetic drug. All local anesthetics are neurotoxic in high enough doses. Xylocain ®, however, has had an excellent record of safety. Only during the last years have there been reports on possible toxic irritation and damage by Xylocain used for spinal anesthesia. The aetiology is still not clear. In this connection two early observations by Gordh and his coworkers are discussed.
The issue of general versus regional anaesthesia has been much discussed and debated over the years. Many anaesthesiologists have expressed the view that regional anaesthesia may result in better outcome than general anaesthesia and there are indeed studies supporting that opinion (1). However, although regional anaesthesia may be the preferable technique for minor surgery in adults e.g. in the distal extremities, most studies have failed to demonstrate any difference in outcome between regional and general anaesthesia (2,3,4,5). A possible exception is obstetric anaesthesia where 50% of all anaesthesia related maternal deaths occurring in the United States during 1979-1990 (n=152) were associated with general anaesthesia and 22% were related to regional anaesthesia (6). Furthermore in recent years regional anaesthesia has been much more used for caesarian sections than general anaesthesia (7). Nevertheless recent outcome studies have shown that mortality related to anaesthesia is very low, 0.15/10.000 in a study of 325.585 anaesthesias in Finland (8) and 0.045/10.000 in the CEPOD study of 5oo.OOO anaesthesias in the United Kingdom (9). Thus i t is evident that very large studies are needed to obtain significant difference in mortality between different types of anaesthesia. A major study into perioperative morbidity and mortality involving both regional and general anaesthesia is presently being done in the Netherlands. Clearly there is no ideal anaesthetic method and both general and regional anaesthesia have side effects which on rare occasions may have devastating consequences. New drugs and modem methods of monitoring as well as better quality control have made general anaesthesia very safe. However, airway problems still complicate the management of general anaesthesia in spite of the introduction of the laryngeal mask as well as fiberoptic techniques for intubation. The numerous drugs used in general anaesthesia have various pharmacological effects on different organ systems and are associated with side effects some of which may occasionally be serious. Regional anaesthesia is also very safe. Breivik has reported a study on 6000 patients with epidural analgesia for postoperative pain relief for 25000 patientdays with a complication occurring in only 0.1% of the patients (10). Kehlet has emphasized patient comfort and beneficial effect on patient outcome by the use of epidural analgesia for the management of postoperative pain (11). Regional anaesthesia has been reported to offer advantages by reducing blood loss and thrombe embolic complications (12). However, regional ariaesthesia is associated with adverse effects, most often minor but occasionally more serious and in a recent study Dahlgren and Tornebrandt reported a follow u p of 17.733 patients where they found 13 cases of permanent neurological sequelae after three spinal and ten epidural blocks (13). These are some of the aspects of general versus regional anaesthesia which will be discussed during this pro and con session. Emphasis will be put on patient safety and how we can better provide the patients with safe and effective anaesthesia and secure optimal patient satisfaction.
Several new CPR techniques and devices have been developed and tested since the first report of manual closed-chested cardiopulmonary resuscitation (CPR) nearly four decades ago. These devices and techniques include vest CPR, interposed abdominal counterpulation CPR, active compression-decompression CPR, an impedance threshold valve, intra-aortic balloon pump and phased thoracic-abdominal counterpulsation. Many of these new mechanical advances in the treatment of cardiac arrest are currently undergoing clinical evaluation in patients in cardiac arrest.
Microdialysis is a technique for sampling the chemistry of essentially all organs and tissues of the body. It was conceived of in the early 70th by Delgado's group in the USA and our group in Sweden. The idea was to implant an "artificial blood capillary" in the tissue, perfuse it with a physiological solution, recover molecules that diffuse over the membrane, and analyse the dialysate. The technique is now universally accepted for investigations of the brain and peripheral organs in animals and more than 4000 papers are published using the technique in essentially every organ of the body. The first implantation of microdialysis catheters in human subcutaneous and brain tissue were made ten years ago at the Karolinska institute in order to follow tissue metabolism. The lack of available instruments slowed the development of the technique. However, two years ago suitable catheters, a portable microdialysis pump and a bedside analyser became available. Today more than 200 papers are published on human investigations mainly in the field of diabetes, adipous tissue metabolism, neuro intensive and neonatal care. The microdialysis catheter is a flexible concentric catheter covered with a 10-30 mm dialysis membrane distally. An inlet tube connects to a small portable pump and the outlet tube to a microvial holder. There is one catheter intended for implantation into subcutaneous tissue or resting muscle and another for implantation into the brain. In the clinical situation the microvial is usually changed every 1W min and the sample analysed in the bedside analyser and then often brought to the laboratory for a more extensive analysis of various analytes. The usefulness of microdialysis rests on two features of the technique: 1) It samples the chemistry in individual tissues and organs as opposed from blood samples and 2) It allows very frequent sampling without any removal of blood or tissue from the body. In the first case microdialysis represent a new and unique possibility to follow tissue metabolism, for example during hypoxia or ischemia as well as the local concentration of drugs and other exogenuous substances. In the second case it is a well tolerated technique for monitoring, for example, a diabetes patient in order to adjust insulin treatment or a neonate where frequent blood sampling is a severe problem. There is a strong interest for applying microdialysis in various clinical situations: In vascular and plastic surgery for monitoring preand postsurgical tissue metabolism. In intensive care for monitoring metabolism after multi trauma and sepsis. In neurointensive care for monitoring brain trauma and hemorrhage. In neonates for minimizing blood samp ling and during and between hemodialysis treatments for monitoring tissue urea. The analytes of immediate interest for bedside monitoring are glucose, lactate, pyruvate, glycerol, glutamate and urea. The lactate/pyruvate ratio is of particular interest for distinguishing hypermetabolism from hypoxia and ischemia. Glycerol, being the end point of lipolysis, is an indirect measure of sympathetic activity but, especially in the brain, an interesting marker for cell membrane disintegation. Glycerol is an integral component of the double layer of most membranes in the body and cell damage and calcium influx activates phospholipases which start the membrane break down and the liberation of glycerol into the extracellular fluid. We hope that microdialysis will become a valuable tool for the anaesthesiologist in an number of clinical situations, in the operating room and in intensive care and in countless research applications on tissue and drug metabolism.
Liquid ventilation (LV) is an exciting, up-and-coming technique presently under investigation for the treatment of acute respiratory distress syndrome (ARDS) and infantile respiratory distress syndrome (IRDS). Two different methods of LV, total liquid ventilation (TLV) and partial liquid ventilation (PLV), are described in this article using a liquid called perflubon. This type of therapy has been shown to positively affect the physiologic derangements seen in ARDS and IRDS cases, and may have additional benefits, including anti-inflammatory properties and synergistic characteristics with other known and experimental therapies.
