Anästhesie, Intensivtherapie, Notfallmedizin
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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 · Aug 1986
Comparative Study[High frequency jet ventilation in patients with acute respiratory failure. A comparison with conventional artificial respiration].
The major advantage of High Frequency Jet Ventilation (HFJV) in the treatment of patients with ARDS was commonly seen in better oxygenation and lower airway pressures, compared to conventional ventilation. Furthermore, HFJV seemed to be successful even in those patients in whom conventional ventilation had failed. We compared HFJV (f = 100/min, inspiratory time 40% to 50%) to conventional ventilation (f = 10/min, PEEP 5 to 10 cm H2O). ⋯ Pulmonary artery pressure (PAP 25.0 +/- 5.0 mmHg compared to 19.9 +/- 4.7 mmHg), central venous pressure (10.5 +/- 4.2 mmHg compared to 8.8 +/- 3.0 mmHg), pulmonary capillary pressure (13.3 +/- 4.4 mmHg compared to 11.3 +/- 3.7 mmHg), pulmonary vascular resistance (131.4 +/- 55.0 dyn . s . cm-5 compared to 96.7 +/- 33.7 dyn . s . cm-5) and right cardiac work index (1.38 +/- 0.55 kg . m/m2 compared to 1.05 +/- 0.33 kg . m/m2) were significantly increased (P less than 0.01) under HFJV. The other haemodynamic variables showed no difference between the two ventilatory modes. HFJV was inferior to conventional artificial ventilation in all patients and caused severe hypoxia in several patients, leading to pulmonary vasoconstriction and increased work of the right heart.(ABSTRACT TRUNCATED AT 250 WORDS)
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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)
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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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Anasth Intensivther Notfallmed · Jun 1986
[Respiratory minute volumes following end expiratory CO2 values in artificial respiration in anesthesia].
During artificial ventilation of anaesthetised patients the respiratory minute volumes were estimated after end tidal CO2-values (eeCO2) and correlated to arterial blood gases. In men the mean respiratory minute volume of 130 ml/kg body weight (b.w.) was significantly above the 113 ml/kg b.w. of women. 9.7-year-old boys and 16-year-old men had higher minute volumes (178 ml/kg b.w. and 148 ml/kg b.w. respectively) in comparison to men of 23 years of age. In contrast, no significant difference was seen in the older age groups. ⋯ EeCO2-values of 3.8 to 4.2 per cent by volume stand for a very marked hyperventilation in the pulmonary healthy patient. The arterial alveolar difference of the CO2 pressure (aADCO2) was in the normal range between 1 and 5 mmHg. The end tidal CO2 estimation is a noninvasive and suitable method to exactly meet the ventilatory needs of the anaesthetised patient.