Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 2004
Clinical Trial[Remifentanil analgesia for aspiration of follicles for oocyte retrieval].
Remifentanil is an esterase-metabolized ultra-short acting mu-agonist opioid with a rapid clearance. The aim of this study was to determine the efficacy of remifentanil infusion for the short-lasting, but painful, transvaginal puncture for oocyte retrieval. Eighty consenting adult women (ASA I and II) aged 30.5 +/- 5 years and with a body weight of 69.1 +/- 9.1 kg were enrolled in this prospective study. ⋯ Some patients, however, showed motoric reactions to vaginal puncture, while in other cases significant and clinical relevant decreases in Hb-oxygen saturation occurred. Therefore, we no longer carry out remifentanil infusion for transvaginal oocyte retrieval. We now prefer a remifentanil infusion of 0.2 microg/kg/min and propofol (1 mg/kg initially with intermittent doses of 0.5 mg/kg) combined with assisted ventilation by mask.
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Anaesthesiol Reanim · Jan 2004
Case Reports[Blunt chest trauma with total rupture of the right main stem bronchus--a case report].
Tracheo-bronchial lesions in blunt chest trauma are rare--the incidence is about 1%--but potentially life-threatening events. Indirect signs such as pneumothorax, pneumomediastinum, subcutaneous emphysema or an insufficient expansion of the lungs after drainage of a pneumothorax are ominous. The fastest and most reliable method to assess the definite diagnosis of tracheo-bronchial lesion is fibre-optic tracheobronchoscopy. ⋯ Forty-eight hours later, synchronised independent lung ventilation with two ventilators was established to protect the surgical result. The ventilation was switched to conventional mode a further 48 hours later. Extubation and the remaining ICU stay were uneventful.
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Anaesthesiol Reanim · Jan 2004
Biography Historical ArticleThe influence of Sir Robert Reynolds Macintosh on the development of anaesthesia.
Fifteen years ago, on the 28th of August 2004, one of the British pioneers of anaesthesiology, Sir Robert Reynolds Macintosh, died in Oxford. Since he had a major influence on the development of anaesthesia in Europe and the rest of the world, we felt it would be appropriate to review his life and work. Macintosh was the first Nuffield Professor of Anaesthetics in the University of Oxford, so we provide a brief biography of Lord Nuffield and describe the historical background to the creation of the chair. ⋯ We discuss the wartime research into survival at high altitudes, the design of life-jackets and the efficiency of methods of artificial ventilation, and then show how Sir Robert pioneered a more open approach to the problem of anaesthetic-related deaths. We list some of the anaesthesiological textbooks which were translated into German, and then describe how his overseas travels influenced the teaching of anaesthesiology all over the world. We record Sir Robert Macintosh's connections with East and West Germany and note how he encouraged the development of academic departments of anaesthesia worldwide.
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As a basis for quality assurance measures, we analysed over a period of three years all iatrogenic tracheobronchial injuries that had to be repaired operatively at a university hospital. Twelve patients were affected. In most of these cases, the injuries were the result of an intubation during resuscitation attempts prior to or after admission to hospital (6 patients; 4 of them died later). ⋯ No such serious tracheal injuries were observed. The cause of death in the patients with tracheal injuries was mainly the underlying disease (resuscitation after myocardial infarction; tracheostomy because of pulmonary failure in septic disorders); however, it is likely that the injuries or the surgical intervention played an additional role in the negative outcome of the patients. The conclusion is that this complication rate must be reduced by in-service training and alteration of the procedures.