Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2002
Historical Article[The centennial of oxygen-therapy (1902 - 2002)--reassessing its history. Part I: "The long way of oxygen"--from its discovery to its implementation as a rational therapy in anaesthesia and emergency-medicine].
This historical survey in two parts analyses the history of inhalative oxygen therapy and its interactions with the history of anaesthesiology. For this purpose, we will start with illustrating "the long way of oxygen" from its first isolation by Carl Wilhelm Scheele (1772) and Joseph Priestley (1774) to its breakthrough for therapeutic application in the 20th century. We will show that the two main factors delaying the successful implementation of a truly rational oxygen therapy were of technical nature: The complicated and costly production of the gas and insufficient means to apply it continuously and with reliable and sufficient dosages to the patients. ⋯ Here, a special significance is to be awarded to pressure reducing valves. These were first introduced into medical technology by Draeger Inc. (Lübeck/Germany) on a significant scale, proving particularly successful in anaesthesia and rescue-devices (e. g. in the "Roth-Draeger Anaesthesia Apparatus" [1902]). Critically discussing earlier research on the history of oxygen therapy, we therefore propose a historical reassessment, accepting the year 1902 as the internationally decisive "turning point" towards the development of modern oxygen therapy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2002
Randomized Controlled Trial Clinical Trial[Influence of positioning on the quality of unilateral spinal anesthesia].
Unilateral spinal anaesthesia ("hemi-spinal") is theoretically associated with the advantages of fewer cardiovascular effects and longer duration of action while offering high density motor block of the extremity affected. ⋯ Unilateral spinal anaesthesia ("hemi-spinal") is an attractive concept, supposed to be associated with the above mentioned advantages and the additional benefit of a partially maintained sensation of one limb. The results demonstrated in this study seriously question this theoretical concept. The most likely reason for the lack of inter-lateral differences in sensory block is the high concentration of hyperbaric local anaesthetic in the cerebrospinal fluid on the dependent side, which, on turning the patient to the supine position, will transit to the previously non-dependent side subsequently leading to a significant block.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2002
Case Reports[Epiglottic abscess as a rare reason for airway obstruction in adults].
Acute epiglottitis in adults is a potentially life-threatening disease of increasing incidence. Although pharyngitis is the most common cause of sore throat in the adult, acute epiglottitis must be considered in the differential diagnosis when there is unrelenting throat pain and minimal objective signs of pharyngitis. ⋯ Patients with acute painful dysphagia should be considered to have epiglottitis until the diagnosis is proven. Early diagnosis and aggressive airway management can be life saving.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2002
[Mechanical interaction between patient and ventilator in biphasic positive airway pressure (BIPAP)--digital and mechanical simulations].
Biphasic Positive Airway Pressure (BIPAP) and the closely related Airway Pressure Release Ventilation (APRV) are characterised by asynchronous actions of ventilator and patient. Clinical observation and physiological reasoning suggest, that in BIPAP patient and ventilator can interact in various ways. This study was to elucidate the mechanical interaction. ⋯ Patient efforts were most likely to effect a breath if they were strong relative to the machine pressure swing, and if they occurred late in a ventilator phase. Conversely, efforts occurring with or shortly after a machine pressure swing or relatively weak efforts were more or less ineffective. The postulated permanently unrestricted spontaneous breathing in BlPAP mode, although indeed assured in the technical sense, has to be qualified: Every change in machine pressure defines a new balance of the forces driving the RS, and the lung volume will approach a new elastic equilibrium volume ( = relaxation volume); the speed of this approach is determined by the time constant (tau = R x C) of the RS. Patient efforts are most effective when the RS is at or close to an equilibrium. An increase in the assisting machine pressure swing can unload the patient and assure a minimum ventilation, but it reduces the patient"s influence on ventilation and thus potentially patient comfort. In contrast, Automatic Tube Compensation (ATC), an assist component accelerating the RS by reducing resistances, combines unloading with more patient influence; this has to be weighed against the potential disadvantage of higher peak flows.