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Die größte Angst eines Patienten während einer Operation ist es, den Eingriff bewusst mitzuerleben oder sogar Schmerzen wahrzunehmen. Mit der Möglichkeit, den Menschen während einer Operation gesteuert in die Bewusstlosigkeit zu führen, galt deshalb ein großes Maß der Aufmerksamkeit des Anästhesisten, dieses Trauma zu vermeiden. Anfangs waren zur Beurteilung nur Herzfrequenz- oder Blutdruckanstieg interpretierbar. Mit Entwicklung des EEG sowie fortschreitender Computertechnik wurden in den letzten 10 Jahren prozessierte Parameter aus dem nahezu chaotisch aussehenden EEG abgeleitet – diese erlauben unter Messung der vorliegenden Hirnrindenaktivität Rückschlüsse auf die Narkosetiefe. Dieser Beitrag stellt Möglichkeiten, aber auch Grenzen der Verfahren zur Messung der Narkosetiefe vor. Zudem wird ein Ausblick auf möglicherweise bald anwendbare neue Techniken gegeben. / Most patients fear a situation in which they remain aware of ongoing surgery, or even perceive intense pain, despite anaesthesia. Ever since the possibility to perform anaesthesia has existed, great efforts have been invested to eliminate the possibility of such a misfortune. Initially, only clinical signs of awareness, such as an increase in heart rate or blood pressure, could be used to assess the depth of anaesthesia. Since the development of electroencephalography (EEG), and with the advances in computer technologies, a number of processed parameters can be derived from EEGs and are able to minimise the risk of such occurrences. In the present article, the different approaches are described together with potential limitations. In addition, an outlook is presented to identify future technologies able to detect awareness during anaesthesia.

This study investigated Ontario dentists' views and use of sedation and general anaesthesia (GA) (n=1076; 37.9% response rate). A mixed mode format offered mailed and web survey options. Study participants were 69.7% male, 83.0% general practitioners, practicing 0.5-42 years (mean 20.6 years), with 40.6% from cities >500,000. 60.2% of respondents provided sedation. Dentists' underestimated patient interest in sedation/GA (66.8% vs. 43.9% not interested; 19.8% vs. 42.8% possibly interested; 13.4% vs. 12.4% definitely interested). Patients' preference for sedation/GA by service was also underestimated (p<0.001) except for extractions. Barriers to care were cost (72.2%) for providers; lack of training (38.2%) and patient demand (25.3%) for non-providers. Dentists reported use of sedation highest for extractions (1.5% deep sedation/GA-5.7% nitrous). Dentists' also overestimated patients' level of fear (somewhat afraid 19.95 vs. 9.8%; very afraid 10.6% vs. 2.0%; terrified 6.0% vs. 3.5%). This study confirms differences between dentists' use and estimation of patient demand for sedation/GA.

This study investigated Ontario dentists' views and use of sedation and general anaesthesia (GA) (n=1076; 37.9% response rate). A mixed mode format offered mailed and web survey options. Study participants were 69.7% male, 83.0% general practitioners, practicing 0.5-42 years (mean 20.6 years), with 40.6% from cities >500,000. 60.2% of respondents provided sedation. Dentists' underestimated patient interest in sedation/GA (66.8% vs. 43.9% not interested; 19.8% vs. 42.8% possibly interested; 13.4% vs. 12.4% definitely interested). Patients' preference for sedation/GA by service was also underestimated (p<0.001) except for extractions. Barriers to care were cost (72.2%) for providers; lack of training (38.2%) and patient demand (25.3%) for non-providers. Dentists reported use of sedation highest for extractions (1.5% deep sedation/GA-5.7% nitrous). Dentists' also overestimated patients' level of fear (somewhat afraid 19.95 vs. 9.8%; very afraid 10.6% vs. 2.0%; terrified 6.0% vs. 3.5%). This study confirms differences between dentists' use and estimation of patient demand for sedation/GA.

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<i>Background</i>. Today, Mendelson's syndrome (pneumonitis following the aspiration of gastric contents) is a major cause of the small, but apparently irreducible number of maternal deaths associated with anaesthesia. Previous research has been directed at the relationship between the physical characteristics of the aspirate and the severity of the ensuing pneumonitis. Prophylaxis, logically based on this knowledge has been directed at reducing the volume and increasing the pH of the stomach contents of women in labour, and at specific measures to reduce the risk of aspiration at the induction of anaesthesia. Despite this, the maternal mortality attributed to Mendelson's syndrome remains essentially unchanged. The operation of an additional, but previously unconsidered variable might explain both the apparent increase in severity of Mendelson's syndrome and the failure of prophylaxis. This thesis reports attempts to elucidate the place of lung water content in this context. <i>Review of the literature and theoretical discussion</i>. This falls into two distinct but inter-related categories: (a) Circumstantial evidence, already existing in the literature for lung water handling being altered in pregnancy and the puerperium, for example the reports of B₂ sympathomimetics inducing pulmonary oedema when used for tocolysis. (b) A detailed review of the present understanding of the pathogenesis of pulmonary oedema, together with the alterations in maternal physiology which accompany normal pregnancy. The two have not previously been considered in conjunction. From this base it is possible to proceed to a theoretical prediction of the consequences of such common interventions as the use of intravenous fluids, oxcytocics and endotracheal intubation under light general anaesthesia. <i>Clinical Study - Normal Primagravidae</i>. Twenty normal primagravidae were investigated for evidence of increased lung water. Detectable increases were found in seven. There was a positive correlation with plasma volume and water turnover. <i>Clinical Study - Pre Eclampsia</i>. Seventeen primagravidae having a pregnancy complicated by pre eclampsia were investigated for evidence of increased lung water. Detectable increases were found in six. There was a positive correlation with fluid balance. <i>Mouse Model</i>. The lungs of pregnant and non pregnant MF1 mice were examined by electron microscopy to confirm and if possible elucidate the expansion of the interstitial tissue detected by the clinical study. A stereological method of point counting allowed volumetric quantification of the tissue components and measurement of surface areas and thicknesses. The results showed that in pregnant mice: (1) Total lung volume was increased but not significantly; (2) The volume and surface area of alveolar lining cells was increased; (3) Pulmonary blood volume was unchanged; (4) Capillary surface area was unchanged; (5) The interstitial compartment was expanded. Within this compartment: The cellular component was unchanged The volume of collagen was unchanged The amorphous component was enlarged Basal lamina volume was increased <i>Appendix A</i>. A magnetic resonance imaging method of lung water measurement was developed with the intention of using it in pregnancy but was not sufficiently sensitive for this purpose.

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1 v. (various paging) : ill., tables, graphs ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.1978) from the Dept. of Human Physiology and Pharmacology, University of Adelaide

Thesis (Ph.D. 1978) from the Department of Human Physiology and Pharmacology, University of Adelaide.

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