Zentralblatt für Chirurgie
-
The ideal solution for volume therapy is still under discussion. In cardiac surgery, hemodynamic efficacy as well as the influence of cardiopulmonary bypass (CPB) are of major interest when administering volume. Hypertonic sodium (HS) solutions which have been advocated for resuscitation from hemorrhagic shock may also be of benefit in cardiac surgery patients. ⋯ Infusion of HS-HES after weaning from CPB resulted in overall more improved hemodynamics than volume replacement with 6% HES. Rapid infusion of HS-HES during CPB (within 2 min) was followed by a significant, but shortlasting decrease in MAP (-40 mm Hg) and an increase in the oxygenator volume. Preoperative infusion of HS-HES resulted in a significant improvement in skin capillary microcirculation assessed by lased Doppler technique during and after CPB.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Laparoscopic surgery may be associated with increased perioperative morbidity due to respiratory and cardiocirculatory problems. Preoperative assessment requires a diagnostic program including laboratory tests and noninvasive diagnostic studies, and a physical status classification. ⋯ Increased intraoperative morbidity is expected in patients with manifest cardiac failure or severely restricted pulmonary function. In patients with moderate pulmonary dysfunction laparoscopic procedures seem to be associated with the benefit of a better postoperative pulmonary function.
-
No data exist in the literature pertaining to the problems of laparoscopic surgery in infants and children. However it is reasonable to assume that minimal invasive surgery will find increasing application in these patients in the future. The anesthesiological problems met during surgery are representatively demonstrated and discussed in the context of a case report. ⋯ This can be prevented by ventilating with a sufficient level of PEEP. On the other hand, the reduction of venous return caused by increased IAP and aggravated by the necessarily high PEEP can compromise circulation. Adequate volume substitution is essential.
-
The present investigation was initiated to quantify the effect of a CO2-peritoneum on CO2-absorption (VCO2res) and other respiratory variables during laparoscopic surgical procedures. ⋯ This increase in ventilation can easily be established in pulmonary uncompromised patients. Problems in adequately increasing minute volume are expected in chronic obstructive lung disease and with maximal VCO2res. Monitoring of at least petCO2 is strongly recommended since the individual course of VCO2res cannot be predicted.
-
Blood transfusion became the subject of major interest because of a possible HIV-infection. It should not been forgotten, however, that HIV-infection is not the only of a wide variety of risks. ⋯ One possibility to avoid risks, is the use of autologous blood. The most important requirement, however, remains to operate with a minimal blood loss.