Der Anaesthesist
-
A 41-year-old woman with severe juvenile diabetes mellitus suffered from profound hypothermia after loss of thermoregulation in diabetic ketoacidosis. She was found unconscious, without measurable blood pressure; the electrocardiogram (ECG) showed bradycardia of 30 min and the rectal temperature was 23.7 degrees C. The patient received mechanical ventilation, fluid therapy, warmed gastric lavage, and, unfortunately, inotropic medication. ⋯ Sinus rhythm resumed without antiarrhythmic medications at a temperature of 29.5 degrees C, and within 8 h the patient was rewarmed to 35.5 degrees C. After treatment of the adult respiratory distress syndrome caused by pneumonia, she was discharged from the intensive care unit to complete treatment with no evidence of any permanent organ damage. We conclude that hemofiltration may be the method of choice for rewarming deeply hypothermic patients when their circulation is preserved.(ABSTRACT TRUNCATED AT 250 WORDS)
-
After laparoscopic cholecystectomy, carbon dioxide (CO2) must be exhaled after resorption from the abdominal cavity. There is controversy about the amount and relevance of postoperative CO2 resorption. Without continuous postoperative monitoring, after laparoscopic cholecystectomy a certain risk may consist in unnoticed hypercapnia due to CO2 resorption. ⋯ There is no significant resorption of CO2 from the abdominal cavity later than 30 min after releasing the KP. Up to this time, any CO2 remaining in the abdominal cavity after careful emptying by the surgeon has been resorbed and exhaled. An increased PeCO2 as late as 30 to 90 min postoperatively should rather be considered a consequence of residual anaesthetics and narcotics than of CO2 resorption.
-
Clinical Trial
[Topographic electroencephalometry following anesthesia induction with ketamine-midazolam].
The neurophysiological action of ketamine has attracted increasing interest in recent years, with special interest in receptor action and in neurophysiological differences between and psychomimetic side effects of the two enantiomorphs. Most of the neurophysiological examinations published deal with ketamine as a single anaesthetic agent, although it has been suggested to that psychomimetic side-effects and haemodynamic deterioration could be avoided by combining ketamine with a sedative drug. The primary aim of our study was to examine the combined ketamine-midazolam action on cerebral activity; secondly, we planned to look at these interactions topographically at different points of the cortex to evaluate topographical differences in the combination's action; thirdly, the cerebral and haemodynamic reactions to anaesthesiological stimuli (intubation, gastric tube) were evaluated and compared. ⋯ Thus, the action of combined ketamine and midazolam on cerebral function is not an additive, but an interactive process. Despite a relatively high induction dosage, haemodynamic changes during intubation occurred and were accompanied by changes in cerebral activity. This can be regarded as incomplete cerebral suppression even by these induction dosages.
-
Case Reports
[Difficult intubation due to facial malformations in a child. The laryngeal mask as an aid].
Variations in anatomy of the bony and soft-tissue structures of the neck and facial cranium due to trauma, disease, or dysmorphic syndromes may lead to severe intubation problems. These patients are admitted for mandibulofacial and otolaryngologic surgery. It is important to inspect the patient's outer and inner pharyngeal structures carefully during preoperative assessment, as suggested by Mallampati. ⋯ The patient's jaw was hypoplastic with aplasia of the temporo-mandibular joint, which led to asymmetry of the lower face and an extremely short mandible. Additionally, we observed a large tongue in relation to the small jaw. Macrostomia is part of the syndrome, and may lead to underestimation of intubation problems.(ABSTRACT TRUNCATED AT 250 WORDS)