Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1994
Randomized Controlled Trial Comparative Study Clinical Trial[Randomized use of an active compression-decompression technique within the scope of preclinical resuscitation].
Despite its worldwide propagation, external chest compression is of limited efficacy. Recently a new method of cardiac resuscitation, active compression-decompression (ACD), was presented. In animals and a small series of patients resuscitated within the hospital ACD proved to augment blood flow during cardiac resuscitation as a result of greater intrathoracic pressure gradients. ⋯ Methods to verify the efficacy of ACD in dummy training should be developed. Paramedics performing ACD should relieve each other every 5 minutes. In patients resuscitated by ACD self-adhesive defibrillation paddles instead of electrode gel should be used. Modifications in the design of the CardioPump are desirable to enhance the efficacy of ACD. With regard to future multicentre trials all paramedics should be skilled in the new technique to reach more patients in a shorter period of time.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1994
Review Case Reports[Mediastinal tumor and airway obstruction in general anesthesia. Case report and review of the literature].
Case report of an acute airway obstruction during general anaesthesia by compression of the left main bronchus in an asymptomatic patient with unknown mediastinal mass. The patient was scheduled for a relief of a thyroid gland cyst. The compression occurred after uneventful induction of anaesthesia during the patient's positioning with flexed neck and elevated upper thorax on a pad. ⋯ The intraoperatively suspected mediastinal tumour was confirmed by postoperative computerised tomography of thorax and neck. The teratoma was removed in toto in a second operation. In a review of the literature pathophysiological changes, preoperative assessment and anaesthetic management of patients with mediastinal tumour are discussed.
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In 1994, thiopentone has been in clinical use as an induction agent for 60 years. For this reason, a literature review is given dealing with its chemical properties and pharmacokinetics with special regard to plasma protein binding, recommended speed of injection, diaplacentar transfer to the foetus in Caesarean section and the transfer to breast milk. The pharmacodynamics of thiopentone are reviewed with emphasis on the effects on the CNS, the cardiovascular system, the respiratory system, renal function, liver and the effect in porphyria. ⋯ The clinical importance of thiopentone in anaesthesia induction and the present state of cerebral protection are discussed, as well as the results of controlled trials comparing thiopentone to other induction drugs. Thiopentone has the main disadvantage of a slow elimination resulting in minor CNS depression, which seems of very limited clinical importance. In most respects thiopentone seems to be comparable to its younger competitors.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 1994
[Effects of propofol and fentanyl on the baroreceptor reflex in geriatric patients].
Increasing age and anaesthetics diminish the baroreflex response to acute changes in blood pressure. This study was designed to investigate the effects of propofol and the combination of propofol with fentanyl on the baroreflex activity in geriatric patients. ⋯ Our data demonstrate that in geriatric patients the baroreflex control of heart rate already is attenuated in the awake state. Propofol produces a further reduction in reflex sensitivity to an acute decrease in blood pressure; this effect is more pronounced in elderly patients as compared to younger individuals. Acute changes in posture or circulating blood volume during propofol anaesthesia may result in greater cardiovascular instability in older patients due to the greater impairment of circulatory control mechanisms.