Vaporization is a new application technique for perfluorocarbon that significantly improved oxygenation and pulmonary function in oleic acid-induced lung injury.

The additive properties of general and regional anesthetic techniques are brought together in combined anesthesia to minimise side effects of the individual techniques. Despite a wide experience with both used as single anesthetic techniques, no definite recommendations regarding indications, general contraindications and procedure exist for their combination. Beneficial effects on haemodynamics, respiratory function, intestinal motility and postoperative stress response have been demonstrated for a combination of general anesthesia and thoracic epidural anesthesia (TEA). In addition TEA is favourable in the management of postoperative pain, which has advantageous effects on convalescence especially in a high risk patient group. Nevertheless, until now no reduction of perioperative morbidity and mortality has been demonstrated. Since the combination of two anesthesia techniques theoretically increases the rate of complication, the expected benefit for the patient must predominate. To estimate the risks and benefits of combined anesthesia, the anesthesiologist must be familiar with each single method, as well as with the synergistic effects of both techniques in order to evaluate the individual indication.

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Healthy animals tolerated perfluorohexane vapor well without significant changes in oxygenation and mechanical lung function for 2 hrs. In injured animals, application of perfluorohexane vapor primarily improved peak inspiratory pressure and compliance. The increase of oxygenation therefore could be secondary to an improvement in compliance.

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The inhalation of a PFC aerosol led to a significant improvement in pulmonary mechanics and gas exchange, which was not observed in the other two groups. These data suggest that a small dose of perfluorocarbon will have beneficial effects on gas exchange and respiratory mechanics. Therefore, the non-invasive aerosol application technique seems to be a reasonable alternative to administer perfluorocarbons in severe lung injury.

SummaryThe Narcotrend Ò is a monitor system for the assessment of depth of anaesthesia. The objective of this trial was to investigate the susceptibility of the Narcotrend to electromyographic (EMG) activity when compared with the Bispectral Index (BIS). We enrolled 33 patients undergoing major urological procedures under combined anaesthesia (thoracic epidural analgesia and general anaesthesia). Anaesthetic depth was assessed simultaneously by the BIS XP and Narcotrend. The intended anaesthetic depth ranged between 40 and 55 in the BIS and between D2 and D0 in the Narcotrend. BIS, but not Narcotrend, values correlated significantly (p < 0.0001) with EMG. BIS values between 70 and 80 occurred intermittently above an EMG activity of 35 dB, whereas the Narcotrend and the clinical signs remained unchanged during the period of elevated BIS values. None of the patients reported intra-operative awareness. Increased electromyographic activity does not affect Narcotrend values. Under combined anaesthesia, the Narcotrend monitor is more reliable when compared with the BIS regarding susceptibility to increased EMG activity.

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