Acta Chir Iugosl. 1980 ; 27 Suppl 2(): 13-8.

[Dilemmas in anesthesiology]

Jeretin S.

The article is survaing sone of the latest developement in anaesthesiology. Dilemmas are pointed out in the filed of toxicity of anaestetics and use of scavenging devices. In intravenous anaesthesia ketamine microdrip and new analgesics have widened the scope and the anaesthetist today can chose from a biger pool of i.v. anaesthetic to pick the one best suitable for bis patient. The care for the patient does not only invoive the care for the time the patient is inder anaesthesia but is aimed at a much higher level. Planing anaesthesia starts in praenesthetic clinic and includes evaluation of the patients tolerance for anesthesia and surgery, preanaesthetic treatment and postanaesthetic treatment. Blood replacement during surgery using electric transfusion pumps and filters has shown to be very useful. Patients not only beter tolerate rapid blood losses. Rapid substitution of adequate amount of filtered blood in these patients gives a smother postoperative course. In intesive care there is a diference of opinion between one group of doctors who feel that good results and satisfactory diagustic results can be obtained wilhout the use of microporcessors and the other group wich states that microprocessors would and actualy do improve continous diagnonstic and monitoring i the criticaly ill, an opinion wich I support. Central laboratories are good and give accurate results but are expansive if used for inbetween checks or monitoring. There fore every ICU should have an own laboratory in order to monitor pH, blood gases, Na, K, Hematocrit and osmotic pressure. This notonly lowers the cost but gives the young resident the chance to learn. Pain treatment has become very actuel during last year and pain clinics are being opened in many places. However we hould be aware that a pain clinic should offer at least nerve bloks, stimulation and acupuncture.