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  • 1
    ISSN: 1432-0932
    Keywords: Anterior cervical fusion ; Cervical collar ; Cervical radicular pain ; Muscle strength ; Physiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a visual analogue scale (VAS), muscle strength was measured by a hand-held dynamometer, Vigorometer and pinchometer. Sensory loss and paraesthesia were recorded. The measurements were performed before treatment (control 1), 4 months after the start of treatment (control 2) and after a further 12 months (control 3). A healthy control group was used for comparison and to test the reliability of the muscle-strength measurements. The study found that before start of treatment the groups were uniform with respect to pain, motor weakness and sensory loss. At control 2 the surgery group reported less pain, less sensory loss and had better muscle strength, measured as the ratio of the affected side to the non-affected side, compared to the two conservative treatment groups. After a further year (control 3), there were no differences in pain intensity, sensory loss or paraesthesia between the groups. An improvement in muscle strengths, measured as the ratio of the affected to the non-affected side, was seen in the surgery group compared to the physiotherapy group in wrist extension, elbow extension, shoulder abduction and internal rotation, but there were no differences in the ratios between the collar group and the other treatment groups. With respect to absolute muscle strength of the affected sides, there were no differences at control 1. At control 2, the surgery group performed somewhat better than the two other groups but at control 3 there were no differences between the groups. We conclude that pain intensity, muscle weakness and sensory loss can be expected to improve within a few months after surgery, while slow improvement with conservative treatments and recurrent symptoms in the surgery group make the 1-year results about equal.
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  • 2
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Spritzenpumpen ; hydrostatischer Druck ; Katecholamine ; Vasodilatatoren ; Komplikationen ; Key words Cardiovascular drugs ; Syringe pumps ; Continuous infusion ; Mishaps ; Hydrostatic pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Administration of highly concentrated, highly potent, and therefore highly dangerous drugs with syringe pumps is common in modern anaesthesia as well as in intensive care and emergency medicine. Because of their exact flow rates down to 〈1 ml/h, these pumps are predestined for delivery of drugs with short half-lives, such as catecholamines and vasodilators. But intravenous application of drugs with syringe pumps is not without problems. While it is well known that syringes not fixed correctly into the pump can empty themselves by the influence of gravity, it seems not to be known that hydrostatic pressure can influence the flow rate of a correctly connected system even during continuous infusion. In this situation a change of height of the syringe pump in relation to the patient's position can have tremedous effects on hemodynamics due to unintended acceleration or deceleration of the flow rate. This case report demonstrates that the elevation of a connected epinephrine pump while moving a cardiac surgery patient after ACB operation from the operation table into his bed led to critical increases of heart rate, blood pressure and left atrial pressure. In order to quantify the problem we repeated the situation experimentally. It could be demonstrated that the elevation of the syringe pump by 80-100 cm delivers an additional bolus of 4–5 drops as the central venous catheter outlet. Lowering the pump consecutively leads to the opposite effect. In the case reported, the accidentally administered bolus of epinephrine was 12–15 μg (we use a concentration of 60 μg/ml epinephrine for continuous infusion with syringe pumps). From this accidental observation the following conclusion can be drawn: The change of height, in relation to the patient's position, of a running syringe pump during continuous infusion of highly concentrated cardiovascular drugs may cause considerable, even life-threatening hemodynamic disorders. Even in a closed infusion system (syringe-extension-central venous catheter), hydrostatic pressure influences infusion rate. Elevation of the pump leads to unintended bolus administration, and lowering of the pump is followed by an interruption of the infusion. In the knowledge of this phenomenon, unexpected hemodynamic reactions during transport of critically ill patients cannot always be interpreted as a result of inadequate anesthesia or volume load, but may be a consequence of incorrect handling of the syringe pumps as described in this report.
    Notes: Zusammenfassung Auf der Basis einer Fallbeobachtung wird der Einfluß des hydrostatischen Drucks auf die Kontinuität der Applikationsgeschwindigkeit in einem geschlossenen Spritzenpumpensystem dargestellt. Bei Umlagerung eines kardiochirurgischen Patienten nach Operationsende vom Operationstisch in das Intensivbett wurde deutlich, daß die in dieser Zeitspanne häufig zu beobachtenden Herzfrequenz- und Blutdruckänderungen nicht unbedingt durch eine inadäquate Narkosetiefe oder durch den Umlagerungsvorgang des Patienten selbst verursacht sind, sondern durch das Anheben der laufenden, mit Katecholaminen oder Vasodilatatoren bestückten Spritzenpumpen. Durch die Änderung der Höhendifferenz zwischen Patient und angeschlossener Pumpe – im geschilderten Fall wurde die Pumpenhöhe im Vergleich zum Patienten um +80 bis 100 cm verändert – erhöhte sich der hydrostatische Druck im Infusionssystem, der Patient erhielt unbeabsichtigt und unkontrolliert einen Bolus Adrenalin, der anschließend in einer experimentellen Überprüfung des Phänomens als eine Menge von 12–15 μg quantifiziert werden konnte. Zur Vermeidung ungewollter Kreislaufreaktionen beim Umlagern oder während des Transports kritisch kranker Patienten, die auf die kontinuierliche Zufuhr hochkonzentrierter, kreislaufwirksamer Substanzen angewiesen sind, ist unbedingt darauf zu achten, daß auch bei konnektiertem System und laufender Infusion die relative Höhe der Spritzenpumpen zum Patienten nicht abrupt verändert wird. Durch unbeabsichtigte Bolusgaben (Anheben der Spritzenpumpen) oder kurzzeitige Unterbrechung der kontinuierlichen Infusion (Absenken der Spritzenpumpen) können z.T. schwerwiegende Kreislaufreaktionen induziert werden.
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