title: [Anesthesia in peritoneovenous shunt placement].
abstract: Since 1984 the peritoneovenous shunt has been installed in 33 patients because of resistant ascites. The aim of this study was to find the optimal type of anesthesia in our conditions on our own clinical-patient material. All patients were classified by the ASA, Goldman, Child and Child-Puigh score. The patient, surgeon and anesthesiologist were polled about the quality of anesthesia, and all observed complications were followed, like after different premedications as well as in the course and after different types of neuroleptic anesthesia. General neuroleptic anesthesia was applied in 23 patients (69.7%), one was operated on in ketamine anesthesia (3.0%) and 9 (27.3%) in local anesthesia with 2% Xylocaine. After premedication with Thalamonal in all patients there came to a fall in arterial pressure for more than 20% of initial values and the feeling of uneasiness and fear was present. All patients with local anesthesia absolutely needed additional application of sedation or analgesia, especially during the formation of the subcutaneous tunnel, and neither patient nor surgeon were satisfied with the achieved comfort. During the course of neuroleptic anesthesia with Thalamonal hypotension developed, in 17/20 patients an in 2/20 the presence of prolonged apnea demanded additional artificial ventilation. In the patient operated on in ketamine anesthesia, an acute psychotic reaction developed, followed by visual and acustic hallucinations without signs of metabolic encephalopathy. On the basis of our own experience, we conclude that general neuroleptic anesthesia with the use of Flormidal as an anesthetic and Fentanil as an analgetic, is the method of choice, and that local anesthesia can be recommended only on one operative site (except the subcutaneous tunnel).
authors.affiliation: Medicinski fakultet, Klinika za anesteziju i intezivnu terapiju, Novi Sad.
authors.forename: S
authors.initials: S
authors.lastname: Gavrilović
authors.forename: L
authors.initials: L
authors.lastname: Gvozdenović
authors.forename: B
authors.initials: B
authors.lastname: Jerković-Danicić
authors.forename: M
authors.initials: M
authors.lastname: Pjević
authors.forename: S
authors.initials: S
authors.lastname: Kovacević
mesh_terms: D000758:Anesthesia; D000777:Anesthetics / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010536:Peritoneovenous Shunt
chemical_list: D000777:Anesthetics
vernacular_title: Anestezija za ugradnju peritoneojugularnog santa.