Anästhesie, Intensivtherapie, Notfallmedizin
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The accuracy of oxygen flowmeters is a prerequisite for a predictable oxygen therapy. As a flowmeter seems to be of unlimited service life, they are often not serviced regularly. This can result in errors in the actual oxygen flow of as much as 50% of the preset value.
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Anasth Intensivther Notfallmed · Aug 1986
[Course of central body temperature in the laminar airflow operating room in various anesthesia procedures].
The oesophageal body temperature of 130 patients was measured pre- and intraoperatively. 92% (n = 116) of the operations (implantation or replacement of hip prostheses) were performed in an operating room having a laminar air flow system with horizontal air flow. 9% (n = 14) of the operations (laparotomies) were performed in a room of identical design without an air circulation system. Three different forms of anesthesia were investigated with regard to their influence on interior body temperature: 1) general anesthesia with a volatile anesthetic (INH); 2) peridural anesthesia with additional general anesthesia (KPDA+ITN); and 3) neuroleptic anesthesia (NLA). A drop in temperature during the operation was found in all patients. ⋯ In the operating room with laminar air flow the INH-patients sustained the greatest decrease in temperature; the mean value in the first hour was 1.1 degrees C/h, and up to 4.6 degrees C/3 h toward the end of the operation. There was a comparable drop in temperature in the first hour in patients anesthetized with KPDA+ITN, but the rate slowed down toward the end of the investigation (2.2 degrees C/3 h). NLA caused a characteristic temperature behavior, with an initial fall in temperature, plateau phase, and subsequent rise (total: -1.0 degrees C/3 h) Temperature regulation was influenced least by NLA in the operating room with laminar air flow; thus, in this context, NLA proved to be a favourable form of anesthesia.
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Anasth Intensivther Notfallmed · Jun 1986
[Intraoperative monitoring in artificial respiration of premature and newborn infants. II. Monitoring of arterial oxygenation].
Monitoring of adequate arterial oxygenation serves to avoid periods of hypoxaemia and hyperoxaemia with potentially life threatening or organ-damaging sequelae. Basic clinical monitoring, i.e., inspection and auscultation, is mandatory. ⋯ Invasive monitoring of gas exchange is essential in prolonged or intrathoracic interventions as well as in neonates with cardiopulmonary problems. paO2 can be estimated by capillary blood gas analysis; arterial blood gas analysis, however, is required for exact determination of paO2 and of the arterio-cutaneous pO2 gradient (atcDO2). Intraarterial fibre optic determination of oxygen saturation or determination of paO2 with an intraarterial Clark electrode does not appear to be well suited for intraoperative conditions.
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Anasth Intensivther Notfallmed · Jun 1986
[Protective effect of lidocaine in maintaining the function of peripheral nerves].
The conduction preserving effect of lidocaine was investigated in sheathed vagus nerves of the rabbit. The nerves were preincubated for one hour in solutions containing either 5 (group I, n = 12) or 20 mmol/l glucose (group II, n = 12). ⋯ In contrast, A and C compound action potentials of nerves incubated without lidocaine were extinguished within 69 +/- 5 and 78 +/- 6 minutes, respectively (group I, p less than 0.001) or 106 +/- 9 minutes (group II, p less than 0.005). The results suggest that administration of subblocking concentrations of lidocaine by standard Bier block technique may increase the margin of safety during operations employing a pneumatic tourniquet, especially if the blood flow to the nerves is impaired by vascular diseases or local anaesthetics containing adrenaline.
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Myasthenics must be considered as surgical risk patients. It is imperative to know the exact pathophysiology of the disease pattern with its three types of crisis including their treatment in order to perform safe anaesthesia and to reduce the rate of perioperative complications. In the preoperative phase we must consider a few specific angles besides the routine manipulations: Treatment with cholinesterase inhibitors as practised in myasthenics is continued unchanged or with only slightly reduced dosage up to the day of the operation. ⋯ After surgery the patient is transferred to the intensive care ward in intubated position, extubation being performed only after spontaneous breathing has been safely assured. In postoperative analgetic treatment the opiate antagonist pentazocine (Fortral) showed the best results as far as our experience goes. With careful monitoring, however, it is also possible to employ other highly effective analgesics.(ABSTRACT TRUNCATED AT 250 WORDS)