Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Rates of awakening, circulatory parameters and side-effects with sevoflurane and enflurane. An open, randomized, comparative phase III study].
Sevoflurane is a "new" volatile inhaled anaesthetic currently undergoing phase III clinical trials in Europe and USA. Owing to the low blood solubility, rapid induction of anaesthesia and emergence from anaesthesia would be expected. In this study, we compared emergence times and haemodynamics in patients receiving either sevoflurane or enflurane. Furthermore, all adverse experiences were recorded, and the relationship to the drug administered was rated. ⋯ Emergence time after inhalation anaesthesia depends on (alveolar) ventilation, blood-gas solubility coefficient and, at least for enflurane and isoflurane, on the dose applied (MAC hours). There is no positive correlation between emergence time and dose applied for sevoflurane. Due to the lower blood-gas solubility coefficient (0.6-0.7 for sevoflurane vs. 1.8 for enflurane) pulmonary elimination is faster and emergence time is shorter with sevoflurane. Supplementing inhalation anaesthesia with fentanyl, there is no difference in the time courses of heart rate and mean arterial blood pressure between sevoflurane and enflurane.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1995
[Capnography for bronchoscopy with rigid technique using high frequency jet ventilation (HFJV)].
Rapid bronchoscopy in general anaesthesia still has its precise indications, where the high frequency jet ventilation technique offers several advantages. The monitoring of ventilation, however, has been rather unsatisfactory up to date. We therefore studied capnography in 60 bronchoscopies during HFJV (rate: 100/min; I:E = 0.33; driving pressure: 0.08-0.14 MPa) using a rigid bronchoscope with a distally located sampling port. Continuous capnograms were recorded. End-tidal partial pressures of carbon dioxide (petCO2), however, were obtained from 2-3 single breaths by intermittently reducing the jet-frequency to 10-12/min. After 6 min (MP1: whole group; n = 60) and 18 min of HFJV (MP2: n = 34 of this group) petCO2 values were regularly obtained and compared to pCO2 in synchronously drawn capillary blood samples (pcCO2). The jet driving pressure initially adjusted to body weight, however, was only corrected according to petCO2, aiming at 34 mmHg. ⋯ Capnography in rigid bronchoscopy during HFJV proved a clinically applicable addition to monitoring. Its routine use is strongly recommended in interventional bronchoscopy. The true petCO2 values obtained by intermittent single low frequency jet breathing permit estimates of gas exchange sufficiently exact for clinical purposes and for adjustment of the ventilator setting. Wave forms of the continuously recorded capnogram during HFJV are a warning of impeded ventilation or airway obstruction and, thus, of the danger of barotrauma or hypoventilation. Besides contributing to patient safety, this monitoring method might improve the acceptance of HFJV for bronchoscopy. Furthermore, it can also be applied to rigid bronchoscopy with common ventilation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1995
Case Reports[Apnoeic oxygenation in Boerhaave syndrome].
Boerhaave's syndrome (Hermann Boerhaave, 1724 [5]) stands for the atraumatic spontaneous rupture of the oesophagus, and still represents a life-threatening situation. Contrary to the surgical approach, the anaesthesiological management has been largely neglected so far. ⋯ During thoracic operations adverse situations may arise from the two antipodes artificial ventilation and acceptable surgical access. Alternative respiratory techniques, e.g. one-lung anaesthesia and/or high-frequency jet ventilation, are not always applicable, although the present case report indicates that a double lumen tube should be recommended. However, the clinical use of oxygenation by apnoeic oxygenation is a useful measure that can be realised in a simple and safe manner. The present case report may help to consider this particular alternative also during thoracic surgery (no influence of FRC size on pAO2 decrease). If applied correctly, apnoeic oxygenation obviously increases both the flexibility of the anaesthesist and patient safety, and additionally provides the ability of safe acting in clinical routine settings as well as during emergencies. In summary, knowledge of this technique of oxygenation seems to be an integral part of serious anaesthesiological education and clinical management.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1995
Biography Historical Article[Alfred Kirstein (1863-1922)--pioneer in direct laryngoscopy].
On April 23rd 1895, in Berlin, Alfred Kirstein performed the first direct examination of the interior of the larynx. 23 days after his first view of larynx, he gave a comprehensive demonstration of autoscopy to the Berlin Medical Association. Until then laryngologists had been content with the technique of indirect laryngoscopy using mirrors, a method popularised by Garcia, Türck and Czermak. ⋯ He reported that the removal of foreign bodies from the trachea must be easier through an autoscope then by means of a tracheostomy; furthermore, catheterisation of the bronchi should now present no great difficulties. The similarity between the blades he used and those described in the 1940s by Macintosh and Miller is remarkable.