Der Anaesthesist
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Case Reports
[Pulmonary artery rupture caused by a Swan-Ganz catheter during heart surgery. A successful therapeutic procedure].
A patient with mitral valve stenosis (NYHA IV) suffered a pulmonary artery rupture after valve replacement and weaning from bypass. This event coincided with the measurement of pulmonary capillary wedge pressure. ⋯ After antagonizing the heparin dose and supporting the right heart with epinephrine bleeding was reduced substantially, following which the right pulmonary artery was declamped. In older patients or patients with pulmonary hypertension the following procedures for preventing pulmonary artery rupture should be taken: before inflating the balloon the catheter should be withdrawn into a large vessel; after inflation the balloon the catheter can be advanced to the wedge position.
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Fiberoptic bronchoscopy is a valuable procedure in the diagnosis and treatment of pulmonary disorders and is usually performed under local anesthesia. The local application and ultrasonic nebulization of lidocaine is widely accepted for inducing topical anesthesia in the respiratory tract. We produced local anesthesia of the trachea and bronchial tree by nebulizing lidocaine via high-frequency jet ventilation (HFJV). ⋯ In general, this mode of lidocaine administration produced adequate anesthesia and was safe. None of the patients studied required additional lidocaine doses during bronchoscopy. Heart rates and blood pressures were stable.(ABSTRACT TRUNCATED AT 250 WORDS)
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Stroke volume and cardiac output (CO) can be determined noninvasively by means of the pulsed Doppler technique to measure blood flow velocities in specified regions of the heart or neighboring great vessels along with 2D-echocardiographic imaging to measure the diameter of vessels or valve orifices. Disadvantages of the transthoracic approach, such as precordial inaccessibility and instability of the probe position, have prevented the continuous application of pulsed Doppler echocardiography during surgery. Recently, we presented a new technique using the transesophageal approach with combined pulsed Doppler measurements and 2D-echocardiographic imaging. ⋯ Use of halothane in 8 further patients resulted in a 21.0 +/- 5.9% and 37.3 +/- 11.7% decrease of TDE-CO at 1.0 MAC and 1.5 MAC, respectively. Transesophageal images adequate to determine the cross-sectional area of the pulmonary artery could be obtained in 16 of 27 (59.3%) patients. CO determined by the TDE pulmonary flow method (28 measurements in 16 patients) correlated with the TD-CO, with an r value of 0.91 and SEE 0.49 l/min.(ABSTRACT TRUNCATED AT 400 WORDS)
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The effectiveness of tracheobronchial lavage in the traditional manner with application of a rinsing solution into the endotracheal tube of artificially ventilated patients is unsatisfactory. In order to improve this a new double lumen catheter was developed. Beside the suction channel with a normal diameter is another very small channel, through which a rinsing solution or drugs can easily be applied endobronchially. ⋯ Only suctioning of more than 3.7 ml was accompanied by a rise in the arterial oxygen pressure. Because of continuous artificial respiration, the arterial carbon dioxide pressure was kept constant. Therefore, there is a catheter available that makes it possible to perform a much more effective endobronchial lavage in a shorter period of time.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Onset of the effect and intubation conditions following atracurium, verocuronium and suxamethonium].
1. The onset of neuromuscular blockade following i.v. injection of atracurium 0.3, 0.4, or 0.5 mg/kg; vecuronium 0.08 or 0.1 mg/kg; and succinylcholine 1.0 mg/kg was studied in 205 adult patients during induction of anesthesia by means of the compound action potential (EMG) of the hypothenar muscle, which was indirectly stimulated via the ulnar nerve above the wrist, using the Datex Relaxograph. At the same time, the intubation conditions at 0.5, 1, 2, or 3 min after injection were assessed using a scoring system (Crul 1983) related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of the extremities. 2. ⋯ Motor blockade 1 min after succinylcholine was 98 +/- 2% and intubation conditions scored 11.3 +/- 0.3. Relating intubation conditions to neuromuscular blockade yielded a close correlation and surprisingly good or very good intubation conditions (score more than 10) at a motor blockade of 80% (resp. 20% transmission). 3. Although succinylcholine is still the muscle relaxant with the most rapid onset of action, the new drug atracurium seems to satisfactorily facilitate tracheal intubation within an acceptably short time interval of 2 min after injection.(ABSTRACT TRUNCATED AT 250 WORDS)