Der Anaesthesist
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In a recently published German multicenter study, 25% of the patients with witnessed cardiac arrest outside the hospital were resuscitated successfully and discharged from the hospital. Approximately 100,000 people suffer a fatal cardiac arrest in Germany annually, which is approximately tenfold the number of deaths from motor vehicle accidents. Cardiopulmonary resuscitation (CPR) performed by bystanders is an important part of the chain of survival to minimize the time interval without artificial circulation and ventilation in a cardiac arrest victim. ⋯ This strategy would decrease the inspiratory flow rate and, therefore, peak airway inflation pressure, which is associated with stomach inflation. Animal models indicate that lower esophageal sphincter pressure may decrease rapidly to 5 cm H2O during cardiac arrest, which may further increase the importance of a low peak airway pressure during ventilation with an unprotected airway. Gastric inflation may cause, besides regurgitation, aspiration, and pneumonia, an increased intragastric pressure, which may push up the diaphragm, decrease lung compliance, and induce a vicious circle of hypoventilation and stomach inflation.(ABSTRACT TRUNCATED)
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Thermoregulation and its impairment by anaesthesia and surgery has recently been brought back into focus by researchers and clinicians. All volatile and IV anaesthetics, opioids, as well as spinal and epidural anaesthesia increase the inter-threshold range of thermoregulation from 0.2 degree C to 4 degrees C between vasodilation and vasoconstriction. Thermoregulatory vasoconstriction and shivering occurs in anaesthetized patients at lower core temperatures than in awake subjects. ⋯ These hypothermia-related morbidities therefore have consequences reaching fare into the postoperative period. Prevention of inadvertent hypothermia is always indicated. Forced-air warming is the most effective and safest method to prevent perioperative hypothermia.
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In February 1995 a questionnaire was sent out on perioperative management during neurosurgical operations performed in the sitting position to 136 centres and hospitals within the Federal Republic of Germany that perform neuroanaesthesia. The response rate was 61.02%. Besides the question of perioperative monitoring during neurosurgical operations in the sitting position, we asked about currently used positions for patients during the following neurosurgical operations:posterior fossa, craniospinal and posterior cervical surgery. ⋯ To determine the effect of the recommendations by the DGAI on clinical practice, the survey will be repeated in 1997.
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The reliability of continuous fibreoptic oximetry in cerebral venous blood and its correlation with intracranial and cerebral perfusion pressures (pressure-volume curve) were examined in an experimental porcine study. ⋯ We conclude that in physiological CPP ranges down to 50 mmHg, SjO2 measurement is a reliable method of detecting oxygen desaturation in cerebrovenous blood. Below that CPP value, the fibreoptic catheter showed repeated false-high oxygen saturation values. The accuracy of SjO2 measurement seems to depend on sufficient cerebral blood flow (CBF): with decreasing CBF the amount of cerebral venous outflow is diminished. We believe this is why we could not find a correlation in low CPP ranges with the oximetry catheter. This flow-dependency is a new aspect of fibreoptic cerebrovenous oximetry. The authors recommend that rising SjO2 values after desaturation events be confirmed by blood-gas analyses.