Der Anaesthesist
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Continuous positive pressure ventilation (CPPV) is an established therapy for treatment of acute respiratory failure (ARF). However, cardiac performance may be severely disturbed due to elevated intrathoracic pressure, inducing a decrease in cardiac output (CO) and oxygen delivery (DO2). Alternatively, mechanical ventilation with prolonged inspiratory to expiratory duration ratio (inversed ratio ventilation IRV) has been successfully used in ARF. ⋯ Occlusion of the RIVA coronary artery typically induces an infarction of 35% of left ventricular muscle mass; however, non-ischaemic myocardium reveals an unchanged or increased contractility. Thus, a reduction of left ventricular preload secondary to CPPV mainly contributes to haemodynamic depression, which is less pronounced during IRV due to a lower peak inspiratory airway pressure and mean airway pressure. IRV may be useful for mechanical ventCntCo
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Randomized Controlled Trial Comparative Study Clinical Trial
[Anesthesia induction using etomidate in a lipid emulsion].
The use of etomidate as an anaesthetic induction agent has been hampered significantly by unwanted side effects such as pain on injection and thrombophlebitis. Investigations by Doenicke et al. have shown that the solubilizer propylene glycol is responsible for these side effects and that they can be avoided by the use of a lipid emulsion formulation. It was the goal of the present study to quantitate the reduction of thrombophlebitis and pain on injection following both formulations under double-blind study conditions. ⋯ On the 1st and 2nd postoperative days, examination of the injected vein revealed a significantly higher incidence of symptoms of thrombophlebitis in the group treated with eto-pg (25% vs 3%). CONCLUSION. From these results it is concluded that in terms of vein compatibility the new galenic formulation of etomidate with lipofundin MCT 20% is superior to the propylene glycol preparation while pharmacodynamic properties seem not to be affected.