Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2001
Comparative Study[The asphyxia-cardiac arrest rat model for developing mechanism of effect oriented therapeutic concepts after cardiopulmonary resuscitation].
In order to expand and combine clinical and basic science research opportunities on cardiac arrest, the Asphyxial Cardiac Arrest Rat Model, originally developed at the International Resuscitation Research Center in Pittsburgh, was introduced and adapted at the University of Magdeburg Medical Center. For better utilization of established morphological and biochemical evaluation techniques, the former Sprague-Dawley rat model was adapted for Wistar rats. ⋯ Furthermore, a trend towards a more pronounced secondary blood pressure depression was observed especially during the later half of the first hour after resuscitation. Post-mortem brain evaluations using conventional Nissl and haematoxylin-eosin staining techniques showed--most distinctly in the hippocampal CA1 region--delayed neuronal damage with a peak at 72 hours after resuscitation and with only a few neurons remaining after seven days of survival.
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Epidural analgesia (EDA) is the most effective method of intrapartum pain relief. Its influence on the course of labor continues to be controversial. Although a cause-and-effect relationship has not been proven, this form of analgesia has been blamed for a host of adverse maternal/fetal events during labor, including prolonged first and second stage of labor, dystocia, malrotation of the fetal head and an increased risk of operative delivery (instrumental delivery, Caesarean section). ⋯ Although the Caesarean section rate for women with an EDA was elevated, the total proportion of secondary Caesarean section remained unchanged despite increased use of EDA. Our findings suggest that women selected for intrapartal EDA already represent a population with an increased risk of an unfavourable course of labor, priming of the cervix, increased need of oxytocin and nulliparity. Pain relief in itself is sufficient indication for the use of intrapartal epidural analgesia.
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Measurement of heart rate variability (HRV) in the perioperative period is not yet part of routine monitoring. Because of a lack of standardization, comparison of results of different investigations is difficult. Caution is needed in interpreting data of HRV measurements because of the complexity of autonomic control of the cardiovascular system. ⋯ Because of the ongoing progress in monitoring with regard to acquisition and computer-based analysis of HRV data, it seems at least possible to measure HRV routinely in the perioperative setting. However, the need for standardization requires large prospective and standardized trials. Depending on the results, the clinical relevance of HRV as a relatively simple and non-invasive perioperative monitoring has to be re-evaluated.
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Anaesthesiol Reanim · Jan 2001
Randomized Controlled Trial Clinical Trial[Hyperoxia-induced liberation of big-endothelin into jugular venous blood of electric neurosurgical patients].
The use of hyperoxia in emergency situations is generally accepted, but the routine and uncritical application of higher oxygen concentrations is criticized. The influence of short-term application of hyperoxia on cerebral oxygenation, cerebral lactate and BIG-endothelin (BIG-ET) was studied. After approval by the Ethics Committee of the University of Leipzig, 22 patients (hyperoxia group n = 16, normoxia, control group n = 6) undergoing an elective craniotomy were included in the study. ⋯ The changes in lactate and BIG-ET were also seen after the end of the hyperoxia. In the control group (normoxia, FiO2 0.4), no significant changes in sjO2, oxygen content, lactate and BIG-ET were observed. The increase in jugularvenous BIG-ET and the decrease in the arterio-jugularvenous difference of BIG-ET following hyperoxia indicate a higher cerebral release of BIG-ET.
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Over the last years, ambulatory anaesthesia has gained more significance within the realm of anaesthesiology in Germany. The German health care system aspires to improve the link between ambulatory and clinical health care. Also, the increasing percentage of older people has changed the demographics of society considerably. ⋯ It also reviews important structural and procedural requirements and recommendations for the implementation of ambulatory anaesthesia. Topics included are technical requirements, equipment, selection of patients, informed consent, fasting regulations, choice of anaesthetics and postoperative care. In order to accomplish a favourable outcome quality in ambulatory anaesthesia, professional judgement and implementation of the respective guidelines appear to be important rules of conduct.