DerAnaesthesist.50440785.ger.abstr-passage-0
abstract
Wir berichten ueber einen Patienten mit einem malignen Melanom der Aderhaut , bei dem es intraoperativ unter kontrollierter Hypotension und Hypothermie ( 31,3 Grad C ) zum Verlust der Wellen I und II der fruehen akustisch evozierten Potentiale ( FAEP ) kam . Nach Anhebung des mittleren arteriellen Drucks von 48 auf 77 mmHg waren die FAEP-Wellen sofort wieder ableitbar , obwohl die oesophageale Temperatur um 0,3 Grad C abgefallen war . Das ebenfalls abgeleitete 2-Kanal-Elektroenzephalogramm ( EEG ) zeigte im betreffenden Zeitraum keine Auffaelligkeiten . Ein beidseitiger reversibler , offensichtlich blutdruckabhaengiger Ausfall der Wellen I und II waehrend Hypotension bei gleichzeitig unauffaelligem EEG ist unseres Wissens bisher in der Literatur nicht beschrieben . Der isolierte Verlust der Wellen I und II bei erhaltenen Wellen III , IV und V ist ungewoehnlich . In der Literatur sind aber Patienten mit Akustikusneurinom beschrieben , bei denen nur die Welle V abgeleitet werden konnte . Ebenso ist ein Fall mit temporaerem Verlust von FAEP-Welle I beschrieben . Als Ursache wird eine lokale Minderperfusion wegen Vasospasmus waehrend Manipulationen in Strukturen des Meatus akustikus internus diskutiert . Ausgehend von anatomisch-physiologischen Besonderheiten der Blutversorgung der Generatoren der FAEP-Wellen kann eine Stenose der Arteria basilaris als Ursache fuer den beidseitigen reversiblen Ausfall der Wellen I und II diskutiert werden . Der Erhalt der Wellen III bis V koennte fuer eine retrograde Fuellung der A. basilaris aus dem Stromgebiet des Circulus Willisii sprechen . Wir interpretieren den beidseitigen Ausfall der Wellen I und II als Folge der Minderperfusion des betreffenden Hirngewebes . Die gleichzeitig bestehende Hypothermie scheidet als Ursache fuer den temporaeren Verlust der Wellen I und II aus , weil die Temperatur des Patienten beim Wiederauftreten der Wellen I und II 0,3 Grad C niedriger war als bei ihrem Verlust .
DerAnaesthesist.50440785.ger.abstr-s1-r1-t4.1-t2.1
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DerAnaesthesist.50440785.ger.abstr-s9-t4
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DerAnaesthesist.50440785.ger.abstr-s1-r2-t5.1-t6.1
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DerAnaesthesist.50440785.ger.abstr-s12-t1
DerAnaesthesist.50440785.ger.abstr-s1-r9-t5.1-t4.1
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DerAnaesthesist.50440785.ger.abstr-s12-t1
DerAnaesthesist.50440785.ger.abstr-s1-r15-t6.1-t5.1
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DerAnaesthesist.50440785.ger.abstr-s1-r21-t3.1-t4.1
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DerAnaesthesist.50440785.ger.abstr-s12-t3
DerAnaesthesist.50440785.ger.abstr-s12-t1
DerAnaesthesist.50440785.ger.abstr-s4-r3-t2.1-t3.1
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DerAnaesthesist.50440785.ger.abstr-s4-r5-t4.1-t3.1
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DerAnaesthesist.50440785.ger.abstr-s12-t1
DerAnaesthesist.50440785.ger.abstr-s9-r1-t1.1-t2.2
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DerAnaesthesist.50440785.ger.abstr-s9-r5-t1.1-t2.2
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DerAnaesthesist.50440785.ger.abstr-s9-t2
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DerAnaesthesist.50440785.ger.abstr-s11-r3-t3.1-t2.1
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