Der Anaesthesist
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It is a strange contradiction that increasingly sophisticated anaesthesia machines are developed meeting all requirements for rebreathing techniques and the highest safety standards, but the usual anaesthetic management is still based on the use of fresh gas flows that preclude substantial rebreathing. The advantages of rebreathing can only be realised if low-flow anesthesia techniques are adopted. Increasing acceptance of these methods is due to the availability of comprehensive anaesthetic gas monitoring. ⋯ The use of new inhalational anaesthetics such as desflurane that require comparatively high concentrations, or even xenon, will motivate to sparing use. Increasingly stringent health and safety regulations as well as sharpened ecological awareness will prompt anaesthetists to minimise all anaesthetic gas emission according to the possibilities of available equipment. Last but not least, the demand for economical working methods will be an argument for applying low-flow anaesthesia techniques.
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Clinical Trial
[The effect of substitution with AT III- and PPSB-concentrates in patients with terminal liver insufficiency].
Patients with end-stage liver disease frequently develop combined coagulopathies due to increased procoagulant and fibrinolytic turnover as well as thrombocytopenia. The onset of clinical symptoms of a haemorrhagic diathesis requires balanced substitution of coagulation factors, since fresh frozen plasma alone does not always maintain a sufficient haemostatic potential in these patients. This substitution commonly follows standard rules based on the assumption that 0.5-1 IU of a coagulation factor or inhibitor concentrate given per kg body weight will increase its endogenous activity by 1%. We set out to investigate the validity of this standard regime in patients with end-stage liver disease scheduled for orthotopic liver transplantation. ⋯ In patients with end-stage liver disease standard rules for substitution with AT III-concentrate are adequate only for patients with CLF. In patients with ALF higher AT III doses are required to achieve the expected effect on endogenous AT III activity. Procoagulant activity, as reflected by PT, can be increased by 1% when 1.6 IU/kg PPSB concentrate is given. However, this study shows the effects of coagulation concentrates only 30 min after administration. An increased volume of distribution and increased turnover may explain the poor recovery of AT III activity in the ALF group, indicating that the dose of coagulation concentrate should be estimated against the background of the patient's clinical symptoms and diagnosis.
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A 45-year-old, healthy, well-trained man climbed within 12 hours from 300 m above sea level to a shelter at 2500 m in the Tyrolean Alps. During the following 3 days he undertook ski tours to the surrounding mountains up to 3356 m. On the 4th day he suddenly suffered from headache, coughing and very severe dyspnoea even at rest, accompanied by loss of appetite and the feeling of suffocation. ⋯ HAPE is a non-cardiogenic pulmonary edema which develops in healthy individuals usually above 3000 m. Among the predisposing factors are rapid ascent, severe physical effort, diminished hypoxic ventilatory response and abnormal fluid balance. The treatment of choice is descent to a lower altitude, administration of oxygen and of nifedipine and expiratory positive airway pressure.
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There is no doubt that a single emergency phone number is desirable, but in contrast to other countries, in Germany different emergency phone numbers and dispatching centers exist for the fire brigade (FB), the emergency medical service system (EMS), and the general practitioners' emergency service (GPS). Due to this fact, valuable time is often wasted by connecting or transferring emergency calls from one dispatching center to another. The purpose of this study was to analyse all calls received by the different dispatching centers in the city and county area of Mainz with respect to total number, fraction of emergency calls, and specificity. ⋯ The EMS dispatching center received 31,286 calls, the five GPS-centers 15,256 calls; 1359 emergency calls that were directed to the police or FB needed transfer to the EMS. During weekdays the EMS and FB received the most calls, with a reduced frequency on Saturdays and Sundays (Table 2). Nevertheless, the highest total numbers of calls were received on Saturdays due to multiple calls directed to the GPS.(ABSTRACT TRUNCATED AT 250 WORDS)
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In the present study, a retrospective statistical analysis of laboratory data, clinical data, and perioperative blood requirements from 300 primary orthotopic liver transplantations (OLT) is described. METHODS. OLT was performed using established surgical techniques and total IV anaesthesia. ⋯ CONCLUSION. According to the data presented, indications for transfusions in OLT according to clotting data are not valid, since these data do not correlate with the blood requirement. In addition, strategies for pretreatment of patients such as preoperative plasmapheresis are no longer justified with respect to possible side effects.