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Algorithms employed as part of entropy monitoring or bispectral index analyse irregularities in the EEG signal. All methods currently have their limitations when used on very old patients, when using ketamine or laughing gas. Expulsion of gastric contents Far more dangerous than awareness during an OP is the expulsion of stomach contents. According to British data it is the most common fatal anaesthetic complication. This is reason enough for German professional societies to formulate recommendations: Small meals such as a slice of white bread with jam or a glass of milk are allowable up to six hours before the induction of anaesthesia. These include, for example, tea or coffee.

Unsuitable drinks include turbid liquids such as those containing milk or fruit pulp particles. Oral medications may be taken with a sip of water until a point of time just before the procedure. Newborns and infants may be breastfed up to four hours before induction of anaesthesia. The possible risk of expulsion being increased by smoking cigarettes is largely negligible. Birgit Larsen from the University of Aarhus delivers new arguments against differentiating between clear and cloudy liquids. She gave healthy subjects coffee with or without milk. After two hours, she ascertained gastric volume by MRI, without finding any significant differences.

Waking delirium Complications may occur even after the procedure has been carried out. Postoperative delirium goes hand in hand with a diversity of disturbances involving consciousness, attention and orientation. Patients have to be cared for longer in hospital. Sometimes they cause self-injury and decide to remove their catheters. Incidence varies from 5 to 15 percent in elderly patients and from 10 to 80 percent with children. US anaesthetists employ ketamine bolus doses in adults, their reasoning being based on results of animal experiments and a Cochrane reviewamong other studies. Avidan, based on the results of his randomised, double-blinded study, raises doubts about this practice.

He randomised patients in three groups: Surprisingly, 20 or 28 percent of those in the verum group hallucinated, compared to 18 percent of those who had only been given the pretend medication. Avidan therefore urges that current practice be reconsidered. The situation looks better for clonidine use after general anaesthesia using sevoflurane and fentanyl. Mogens Ydemann from the University of Copenhagen included children between one and five years of age in her study. They received either clonidine or saline intraoperatively. In the verum group, wake-up delirium was much less common than with placebo, namely 25 versus 47 percent.

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Increased mortality If the patient wakes up, further dangers threaten over the subsequent few days or weeks. Even Young teens pics the absence of any irregularities, myocardial damage and markedly increased mortality occur following non-cardiac procedures. Two research groups independently of one another have now shown that troponine is suitable as a marker. These proteins enter the bloodstream, should cardiac muscle cells be damaged. Devereaux from McMaster University in Hamilton, Canada, evaluated data from 21, patients for an observational study. The patients were on average 63 years old and were operated for varied reasons.

Cardiological indications were not among these reasons. As Devereaux reportsthere were associations between the perioperative level of highly sensitive troponine T hsTnT and day mortality. These results were confirmed by Christian Puelacher from University Hospital Basel using a cohort of 2, patients. In out of 2, operations he detected myocardial damage based on hsTnT values. Neither Devereaux nor Puelacher currently see a possibility of intervening. Brain development Dangers lurk not only for older, multimorbid patients.


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