Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[A new indicator to determine the optimal PEEP (author's transl)].
To elucidate the optimal PEEP for respiratory treatment, respiratory and haemodynamic studies were performed on 12 normovolemic patients with ARDS for various levels of PEEP (PEEP = 0, 5, 10, 20 cm H2O). In this study, it became clear, that Suter's best PEEP (maximal O2 transport should be taken as a reference for optimal PEEP) cannot be used in practice because O2 transport is usually maximal in ZEEP (PEEP=0) and changes with the alteration of FIO2. We propose "intrapulmonary nonshunt flow ((Qt-Qs)" as a new indicator to determine the optimal PEEP. The level of PEEP to achieve the maximal intrapulmonary non-shunt flow must be such that the decrease in intrapulmonary shunt flow is attained with minimal decrease of cardiac output.
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Randomized Controlled Trial Clinical Trial
[Influence of different preinjections on unfavourable side-effects of succinylcholine-induced block (author's transl)].
Pretreatment with a subparalytic dose of a nondepolarizing relaxant is used to prevent side-effects of the succinylcholine (Sch) dose needed for intubation. On the other hand small doses of Sch (self-taming) or lignocaine are recommended to avoid in part reversal of the Sch-induced block caused by nondepolarizing relaxant. 50 patients received different preinjections before Sch-induced relaxation: 2 mg alcuronium, n = 10; 1 mg pancuronium, n = 10; 0.1 mg/kg bw Sch, n = 10; 1 mg/kg bw lignocaine, n = 10; no pretreatment, n = 10. Injection of small doses of Sch or lignocaine prior to the Sch dose needed for intubation, offered no advantage in comparison to the conventional method of pretreatment with nondepolarizing relaxant, concerning intensity and duration of the relaxation, conditions for intubation and muscle fasciculations. After preinjection of Sch or lignocaine a similar rise of serum potassium was observed as without preinjection (0.4-0.5 mEq/l).
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Randomized Controlled Trial Clinical Trial
[The effects of 500 ml 10% hydroxyethyl starch 200/0.5 and 10% dextran 40 on blood volume, colloid osmotic pressure and renal function in human volunteers (author's transl)].
The effects of administration of a new, middle-molecular 10% hydroxyethyl starch 200/0.5 (HAES-steril) were compared to 10% dextran 40 (Rheomacrodex) in 20 hypovolaemic volunteers after withdrawal of 400 ml blood. The total increase of blood volume after 500 ml of 10% hydroxyethyl starch 200/0.5 was 10.19 +/- 1.1 ml/kg (754 ml), after 500 ml of 10% dextran 40 14.10 +/- 1.1 ml/kg (1032 ml), which was significantly higher (p less than 0.01) and in correspondence with the known volume expanding properties of 10% dextran 40. The volume effect after administration of both substances was stable, as demonstrated by the ability to compensate the loss of 400 ml blood for more than 8 hours. ⋯ This hyperamylasemia is caused by the formation of a high molecular hydroxyethyl starch-amylase complex, which cannot be eliminated easily. Urinary volume and endogenous creatinine clearance were increased by administration of both colloids. After dextran 40 a pronounced increase of the urinary viscosity occurred.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
A comparison of alfentanil and fentanyl in short operations with special reference to their duration of action and postoperative respiratory depression.
Ninety women undergoing short gynaecological operations were included in a double-blind comparison of fentanyl and alfentanil, a structurally related and very short-acting narcotic analgesic. Anaesthesia was induced by methohexitone followed by a double-blind injection of either alfentanil (0.5 mg/ml) or fentanyl (0.05 mg/ml). ⋯ Cardiovascular parameters remained stable with both analgesics. There were no troublesome side-effects.
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Randomized Controlled Trial Clinical Trial
[Methods influencing intraoperative heat balance in the sterile enclosure (author's transl)].
More and more operations are performed in a sterile enclosure ("Sterilboxe") with a high fresh air turnover to achieve an optimum aseptic standard. This study investigated the question whether the climate of the "Sterilboxe" has a depressing effect on the body temperature of anaesthetized patients. Furthermore various devices were tested for their value in compensating for heat losses. ⋯ Three methods for the compensation of heat loss were compared each against other and against the control whilst continually recording the oesophageal temperature. In the control group the temperature fall was 0.44 degrees C/h, in the group in which respiratory gases were optimally warmed and humidified the decrease was only 0.11 degrees C/h. Warming up all perfused liquids in a water-bath heat-exchanger showed a fall of temperature of 0.2 degrees C/h; with a Fenwal heatexchanger temperature decreased by 0.27 degrees C/h.