Der Anaesthesist
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Comparative Study
[Acute spinal subdural hematoma after attempted spinal anesthesia].
This is a report of a case of a subdural haematoma with resulting paraplegia after attempted spinal anaesthesia. Epidural and subdural haematomas are rare complications after central neural blockade. The complication described here was the result of an unsuccessful attempt to puncture the spinal channel. ⋯ A similar case was published in 1988 by Parker. In the present case it must be assumed that the vessel was punctured during a paramedian approach in the area of the foramen intervertebrale, as the spinal channel was definitely not entered. Although this is an extremely rare complication, we conclude that close neurological controls are essential at least during the first 24 h after surgery, even after an unsuccessful attempt at central neural blockade.
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Historical Article
[Artificial respiration with technical aids already 5000 years ago?].
Performed at the end of the mummification process, the "mouth-opening" ritual was a ceremony for the spiritual resurrection of the dead Pharaoh. The techniques used are astonishingly similar to modern emergency-room procedures. For example, the mouth-opening device was made of meteoric iron. ⋯ There are other signs of medically sound methods in the mouth-opening ritual. Symbolically, the mummy's teeth were extracted, the eyes opened with a special device, and gold capsules inserted, perhaps in the sense of a breathing tube. There is a possibility that this ritual contains a forgotten synopsis of knowledge gained empirically in connection with the Egyptian cult of royal resurrection.
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Portofemoro-axillary bypass systems are commonly used to treat adverse haemodynamic effects during the anhepatic phase of orthotopic liver transplantation (OLT). However, low shunt flows may reduce the efficacy of these bypass systems. In order to improve veno-venous bypass management, a percutaneous cannulation technique (PCT) was used to insert large-bore catheters (21 F) into the left femoral and subclavian veins. This study prospectively addresses the complications of the PCT in 195 adult patients undergoing 203 OLTs. ⋯ The portofemoro-subclavian bypass can be performed by percutaneous cannulation without additional complications in patients undergoing OLT. Although haemorrhagic complications following central venous catheterisation are reported to occur in patients with haemostatic defects, none of them was observed in this study. Two events of air embolism and one cardiac arrest could not be related to the PCT. In conclusion, femoro-subclavian percutaneous cannulation is a simple, rapid, and safe alternative to commonly used veno-venous bypass systems.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Serum fluoride concentrations and exocrine kidney function with sevoflurane and enflurane. An open, randomized, comparative phase III study of patients with healthy kidneys].
Sevoflurane is a "new" volatile inhaled anaesthetic. Owing to its lower blood-gas solubility coefficient, emergence from anaesthesia is faster with sevoflurane than with isoflurane, enflurane, or halothane. Sevoflurane undergoes metabolic biodegradation, releasing inorganic fluoride ions that could produce nephrotoxicity. In this study, we compared serum inorganic fluoride concentrations (IFCs) in patients receiving either sevoflurane or enflurane. Furthermore, indices of renal function were evaluated until the 3rd postoperative day. ⋯ In our study 1.69 MAC-h sevoflurane produced peak serum IFCs of 34.5 mumol/l. This is in accordance with the investigation of Frink et al. [4], who reported approximately 30 mumol/l after 1.4 MAC-h sevoflurane. Peak serum IFCs with sevoflurane were twice those with enflurane. Within the first 24 h post-anaesthesia, fluoride levels decreased more rapidly after sevoflurane. AUC may be more important than peak serum IFC in evaluating patients who are at risk for renal concentrating defects. In our study there was no evidence of renal dysfunction in either group.
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Acute respiratory distress syndrome (ARDS) is rare but beset with a high mortality rate. In recent years, however, a trend towards higher survival rates has been observed. High inspiratory oxygen concentrations, large tidal volumes, and high peak inspiratory airway pressures applied during mechanical ventilation have been identified as harmful to the lung and can contribute to the progression of ARDS. ⋯ Should these procedures fail to improve impaired gas exchange, extracorporeal membrane oxygenation is an additional therapeutic option. None of these therapeutic procedures, however, has been tested against traditional standard treatment in a classical randomised controlled trial. The following review focuses on the latest insights into the pathophysiology, diagnosis, and treatment of ARDS.