Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1991
Case Reports[The early diagnosis of malignant hyperthermia--the place of end-expiratory CO2 monitoring].
The authors report on the course of a fulminant malignant hyperthermia (MH) associated with laminectomy in a 29-year-old man who had been healthy up to that time. Succinylcholine and isoflurane were considered to be the causative triggering agents. ⋯ Residue-free restitution was achieved within a few days. Decisive for an early detection of MH is the routine performance of end-expiratory CO2 measurement which is definitely superior to temperature control and significantly reduces the time that elapses before treatment is initiated.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 1991
Biography Historical Article[Franz Kuhn (1866-1929) on the 125th anniversary of his birthday].
At the beginning of the 20th century, the German surgeon Franz Kuhn (1866-1929) was the leading protagonist of various endotracheal intubation technics. In the period between 1900 and 1912, he wrote several papers on this topic including a remarkable monograph on intubation, which was not widely appreciated for decades. In this, he discussed--among others--the advantages and possible risks of the endotracheal intubation, for patients during surgical procedures as well as in situations of cardiopulmonary resuscitation. ⋯ He was the first to incorporate a carbon-dioxide absorption system within the anaesthesia apparatus. Later, he developed technical devices for the perioperative intravenous administration of fluids or the injection of local anaesthetic drugs under high pressure. In honour of Kuhn's 125th birthday, the various contributions to anaesthesia and emergency medicine are outlined.
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Several studies have shown that most anaesthesia-related critical incidents are due to human error. There is evidence that cerebral monitoring procedures may be of value for an early detection of cerebral hypoxia or ischaemia. Monitoring of central nervous physiology includes both evaluation of systemic parameters like arterial blood pressure, arterial PO2, PCO2, and temperature, and more specific parameters for the assessment of central nervous system function and intracranial haemodynamics. ⋯ In contrast, non-invasive transcranial Doppler sonography may provide continuous information on intracranial haemodynamics. Relative changes in cerebral blood flow velocity have been shown to correlate closely to changes in cerebral blood flow. Cerebral perfusion pressure can be calculated by monitoring of intracranial pressure in patients with compromised intracranial compliance.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 1991
Review[The endocrine stress reaction in anesthesia and surgery--origin and significance].
Stress can be defined as a "reaction by living beings to any relevant impairment". The effect of anaesthesia on endocrine function is closely related to the actual stress concept based on the works by Cannon and Selye. Cannon described the role of catecholamines in stress and characterised the fight-flight reaction. ⋯ Only few data are available concerning the stress response during infiltration anaesthesia or nerve block, but additional sedation seems to be beneficial. Peripheral interactions with the endocrine system like blockade of the adrenal cortex by etomidate is dangerous and has caused a high mortality in intensive-care patients if the substance was admitted for a longer period. Assessment of endocrine stress response in anaesthesia and surgery is controversial.(ABSTRACT TRUNCATED AT 400 WORDS)