Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1994
[Analgesia and hemodynamics under 8 mu/kg clonidine for pain therapy following major abdominal surgery].
To characterise the haemodynamic profile after epidural injection of high-dose clonidine for postoperative pain management and to establish recommendations for the therapy of haemodynamic instabilities. ⋯ Epidural clonidine 8 micrograms/kg causes rapid and intense analgesia. Haemodynamic instability is a consequence of a drop in heart rate and has to be treated accordingly. The application of a pure vasopressor does not seem to be indicated taking in account the fact that the total peripheral resistance remains unchanged and in the normal range.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1994
[Pain control with paracetamol following inguinal herniorrhaphy or orchidopexy in childhood].
The application of opiates after day case surgery in childhood is discussed controversially because of possible complications. Therefore many anaesthetists try to avoid these substances and prefer peripheral analgesics for postoperative pain control. ⋯ Following herniorrhaphy the postoperative pain therapy with acetaminophen seems to be sufficient. For the postoperative pain treatment after orchidopexy additional measures like local nerve blocks, regional anesthesia or wound infiltrations with local anaesthetics should be considered.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 1994
Randomized Controlled Trial Clinical Trial[Abdominal complications following heart surgery].
Intra-abdominal complications occurring after cardiopulmonary bypass operations are rare but often fatal. There are only speculative approaches concerning the pathogenesis and the risk factors of these complications. The aim of our study was therefore to determine the causative factors and to evaluate the diagnostic and therapeutic measures, because early diagnosis and immediate treatment is essential for the outcome of the patients. ⋯ In reviewing both our results and data cited in earlier studies, intra-abdominal complications can generally be attributed to the following: Intraoperative surgical complications with the consequence of prolonged aortic cross clamping and total bypass times can cause low cardiac output and mesenteric hypoperfusion. Predominantly as a result of the low cardiac output, the use of vasopressors increases splanchnic ischaemia, in particular in patients with pre-existing occlusive vascular disease of the mesenteric arteries. Mucosal ischaemia might be aggravated by a concurrent pseudo-obstruction. On the other hand, intraoperative complications and low cardiac output can cause further complications and finally multiple organ failure. Multiple organ failure and ischaemia of the gut can initiate the vicious circle which is responsible for the high mortality from these complications. Early detection by careful physical examination and the combination of the diagnostic procedures and prompt treatment should lead to a reduction of mortality.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 1994
Case Reports[Successful treatment with hyperbaric oxygen following severe cerebro-arterial gas embolism].
We report on a patient suffering from a severe cerebral arterial gas embolism associated with decompression from a simulated high pressure chamber dive. Treatment with hyperbaric oxygen (HBO) commenced immediately after the accident and was continued subsequently for 8 weeks with a total of 49 HBO-sessions. Despite initial transitory amaurosis and flaccid tetraplegia lasting for two weeks the patient made a near complete recovery except for circumscript numbness and paraesthesia confined to the left tibia and palm. This case underscores the need to consider patients with cerebral arterial gas embolism for HBO treatment and the potential value of a subsequent long-term HBO therapy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 1994
Biography Historical ArticleCurt Schimmelbusch (1850-1895)--development of a mask for chloroform and ether anesthesia based on primary aseptic principles.
The German surgeon Curt Schimmelbusch is not generally recognised as a pioneer in anaesthesia, although he is well known by his investigations concerning the development and scientific foundation of mechanical sterilisation methods which he performed under Ernst von Bergmann in Berlin at the end of the 19th century. His book "Anleitung zur aseptischen Wundheilung" is one of the classics in the history of asepsis. Curt Schimmelbusch was born on November 16th, 1860, as the son of a lord of a manor in Gross-Nogath/West-Prussia. ⋯ His surgical training took place in Cologne where he worked in 1888 with the famous surgeon Bardenheuer at the Bürgerhospital. A year later he returned to Berlin to do research work at the institute at the Ziegelstrasse. Under the main aspects of hygiene he described a mask in 1890, which he used predominantly for ether anaesthesia, although he considered it to be suitable also for chloroform anaesthesia, in itself an exciting contribution he has made characterising the progress of anaesthesia in German-speaking countries up to the mid-50's of the 20th century.