Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Dec 1990
[A modified Macintosh blade with an angulated tip for difficult intubations].
The depth of the proximal part of a normal Macintosh blade was carved more shallow and the tip of the blade was made adjustable in its angle by means of a joint controlled by a screw-lock fixation via a small wire parallel to the blade. Clinical experience with this modified blade in 33 patients is reported. In 10 of 13 patients with severely reduced mouth opening less than or equal to 25 mm and 19 of 20 patients with a mouth opening greater than 25 mm, visibility during laryngoscopy with the modified blade was improved, compared to the normal Macintosh blade. The carved proximal part of the blade improves its maneuverability in a small mouth avoiding undue pressure on the incisors, the adjustable tip increases the blade's pressure on the base of the tongue lifting the epiglottis.
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Anasth Intensivther Notfallmed · Dec 1990
Review Comparative Study[Epidural conduction anesthesia versus general anesthesia. A critical evaluation of outcome studies using as examples cesarean section and patients with hip fractures].
In the field of anaesthesiology, outcome studies are undertaken to investigate the influence of different anaesthetic techniques on the intra- and postoperative course of patients in special clinical situations. The design of these studies should follow high methodological standards. ⋯ Up to now, results do not clearly indicate the use of certain techniques in concrete clinical situations. Decisions must be made in accordance with clinical aspects, individual experience and in cooperation with the patient and the surgeon.
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Anasth Intensivther Notfallmed · Dec 1990
Case Reports[Hypothermia and polytrauma. A case report (28 degrees C)].
In a 29-year-old polytraumatised motorbike driver, massive blood transfusion led to a decrease of the body temperature to 28.1 degrees C rectal on the second day after admission. We could rewarm the patient using only a Clinitron bed, although he had persisting blood loss due to an intravasal coagulopathy. This method has proven to be noninvasive, effective and without any side effects.
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Anasth Intensivther Notfallmed · Dec 1990
[The measurement of extravascular lung water--significant in the follow-up of ARDS?].
In 40 adult patients suffering from severe ARDS stage III and IV (Morel) we examined the course of the extravascular lung water (EVLW) measured by the double indicator dilution method with 858 single measurements, during mechanical ventilation with PEEP, or extracorporeal CO2 elimination (ECCO2 R). No correlation could be found between EVLW and the values of alveolar arterial oxygen difference (AaDO2) and intrapulmonary right-left shunt (Qs/Qt) or haemodynamic values such as CVP, PCWP, mean pulmonary arterial pressure, or the 24 h fluid balance. It was, therefore, not possible to estimate a prognostic trend based on a single measurement of EVLW. ⋯ However, during the ECCO2-R treatment the repeated estimation of EVLW and AaDO2 is a useful tool to assess recovery because other parameters such as Qs/Qt and chest computer tomography during long-term bypass are very difficult or impossible to employ for this purpose. A change of EVLW with increasing PEEP level could not be found. The reproducibility of 858 EVLW values was excellent with a coefficient of variation of 4.9 +/- 3.5%.
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Anasth Intensivther Notfallmed · Dec 1990
[Postoperative apnea--a special risk for former preterm infants].
Infants who had been originally preterm are subject to a particularly high risk after surgical interventions involving anaesthesia, due to a tendency to experience disturbance of respiratory regulation. Of a total of 130 originally preterm infants who had to undergo anaesthesia for so-called minor surgery, respiratory anomalies were seen in 66%, 48%, 10% and 7% of the infants in the age groups of 40, 50, 60 and 80 weeks after conception, respectively. ⋯ To minimise the risk of postoperative early and late apnea in ex-preterm infants, the following measures are presented and discussed: elective surgical interventions should be postponed until after the 50th post-conceptional week; in individual cases, indication for perioperative theophylline/caffeine treatment can be made more precise by means of preoperative ECG-coupled impedance pneumography; all measures of preoperative preparation, choice of anaesthetics and of adjuvant drugs, as well as perioperative infusion therapy, must be taken in full consideration of all neonatal previous diseases; patients up to the 50th week after conception require intensive-care monitoring primary and post-anaesthesiologically for at least 24 hours. In all patients who were older than 50 week after conception, two hours of intensive-care monitoring in the so-called "recovery from anaesthesia room" followed by 12 hours of ECG and apnea monitoring proved sufficient; in ex-preterm infants, even minor surgery should be performed on an in-patient basis only, to ensure proper monitoring.