Der Anaesthesist
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Comparative Study Clinical Trial
[Evaluation of the oscillometric blood pressure monitors: Dinamap 1846 and HP M-1008B].
Using the PTB simulator, which emits real signals from patients, we examined the precision of the oscillometric blood pressure measurement with the Dinamap 1846 (Critikon) and the HP M-1008B (Hewlett Packard). For this purpose we simultaneously registered invasive arterial pulsewave, cuff pressure and cuff pressure oscillations of 20 patients from our intensive care unit and stored them in the database of the simulator. The invasive reference blood pressure values were determined following the recommendations given by the Association for the Advancement of Medical Instrumentation. ⋯ The American Association for the Advancement of Medical Instrumentation recommends a maximum mean error of 5 +/- 8 mmHg. None of the examined instruments lay within these limits. Due to the systematic and stochastic errors, we think that the Dinamap 1846 (Critikon) and the HP M-1008B (Hewlett Packard) do not achieve performance levels that are adequate for measuring critically ill patients.
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Case Reports
[Disturbance of continuous, pump administration of cardiovascular drugs by hydrostatic pressure].
Administration of highly concentrated, highly potent, and therefore highly dangerous drugs with syringe pumps is common in modern anaesthesia as well as in intensive care and emergency medicine. Because of their exact flow rates down to < 1 ml/h, these pumps are predestined for delivery of drugs with short half-lives, such as catecholamines and vasodilators. But intravenous application of drugs with syringe pumps is not without problems. ⋯ Even in a closed infusion system (syringe-extension-central venous catheter), hydrostatic pressure influences infusion rate. Elevation of the pump leads to unintended bolus administration, and lowering of the pump is followed by an interruption of the infusion. In the knowledge of this phenomenon, unexpected hemodynamic reactions during transport of critically ill patients cannot always be interpreted as a result of inadequate anesthesia or volume load, but may be a consequence of incorrect handling of the syringe pumps as described in this report.
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Prerequisites for experimental study designs are extremely difficult to realise under prehospital emergency conditions. Results obtained in animal experiments always need validation with prehospital or in hospital patient studies. Investigations related to emergency medicine are, however, an ethical obligation on behalf of the patient. ⋯ Biases in emergency medicine studies focus on the variability of EMS, personnel qualifications, etc. This is in part why it is extremely difficult to prove efficacy and efficiency in emergency medicine. The results of emergency medicine investigations should be published in suitable journals, i.e., journals with a reasonable rating.
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Postoperatively, after an uncomplicated vaginal hysterectomy, a 58-year-old female patient developed the signs of disseminated intravascular coagulation and fever, which progressed to a septic shock. She received two units of autologous blood, one during and one after the operation. ⋯ The source of bacterial contamination could not be identified. Autologous blood products thus also include a risk of infection that shouldn't be underestimated, and a strict medical indication to retransfusion is indispensable.
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Randomized Controlled Trial Clinical Trial
[The effect of prophylactically administered n-acetylcysteine on clinical indicators for tissue oxygenation during hyperoxic ventilation in cardiac risk patients].
Hyperoxic ventilation, used to prevent hypoxia during potential periods of hypoventilation, has been reported to paradoxically decrease whole-body oxygen consumption (VO2). Reduction in nutritive blood flow due to oxygen radical production is one possible mechanism. We investigated whether pretreatment with the sulfhydryl group donor and O2 radical scavenger N-acetylcysteine (NAC) would preserve VO2 and other clinical indicators of tissue oxygenation in cardiac risk patients. ⋯ NAC helped preserve VO2, oxygen delivery, CI, LVSWI and PvaCO2 during brief hyperoxia in cardiac risk patients. Clinical signs of myocardial ischemia did not occur such as ST-depression if patients were prophylactically treated with NAC. This suggests that pretreatment with NAC could be considered to attenuate impaired tissue oxygenation and to preserve myocardial performance better in cardiac risk patients during hyperoxia.