Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Case Reports[Combined sciatic nerve-3 in 1 block in high risk patient].
We report on a case of combined sciatic nerve block and 3-in-1 block for amputation of lower limb in an ASA IV-V patient 6 days after intraoperative cardiopulmonary resuscitation following induction of general anaesthesia. ⋯ The combined sciatic and 3-in-1 block is a rarely used technique, but for haemodynamically unstable patients it is a safe method for surgery of the lower limb.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Histamine plasma concentration and cardiovascular effects of non-depolarizing muscle relaxants: comparison of atracurium, vecuronium, pancuronium and pipecuronium in coronary surgical patients at risk].
Cardiovascular effects of four commonly used non-depolarising muscle relaxants and their ability to increase histamine plasma concentrations were studied in patients scheduled for coronary artery bypass grafting. ⋯ All investigated neuromuscular blocking agents exhibited marked cardiovascular stability which permits their use, being based exclusively on pharmacodynamic and pharmakokinetic considerations even in patients with coronary heart disease. If an increase in heart rate appears beneficial Pancuronium may be advantageous.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Review[Aspects in monitoring and treatment of gastrointestinal underperfusion in sepsis. Diagnosis and therapy of gastrointestinal underperfusion in sepsis].
Tissue hypoxia, especially in the splanchnic area, is still considered to be an important cofactor in the pathogenesis of multiple organ failure. Thus, in the treatment of septic shock the specific effects of ino-tropic drugs on the splanchnic perfusion are of particular interest. To give strict recommendations for monitoring and for therapeutic strategies in the treatment of gastrointestinal failure in patients with sepsis is difficult not only due to the lack of data on clinical outcome and organ dysfunction, but also due to some limitations in the methods applied to assess splanchnic perfusion and oxygenation. ⋯ Epinephrine and dopamine should be avoided because they seem to restribute blood flow away from the splanchnic region. There are no convincing data yet to support the routine use of low dose dopamine or dopexamine in patients with sepsis. These recommendations are limited by the lack of outcome studies and optimal methods for the assessment of splanchnic perfusion/oxygenation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Review[Tissue oxygenation: physiological and pathophysiologic aspects in intensive care].
Continuous oxygen supply to the tissues is one of the many important factors in intensive care. However, as a basic requirement for the structure and function of higher developed organisms energy production by oxydative metabolism is of outstanding importance, because there is no significant storage of energy and anaerobic metabolism is insufficient. The determinants of oxygen supply--blood flow and oxygen content--are well known. ⋯ Only when an imbalance between oxygen supply and demand--an oxygen debt--is realized at an early stage, the critically ill patient can be saved from irreversible damage. In the field of intensive care the frequently latent tissue hypoxia is often a result of the chronic oxygen debt of individual, particularly vulnerable organs. Considering those aspects the intestinal mucosa is particularly suited for the monitoring of tissue oxygenation in the critically ill patient.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Clinical Trial[Gastric mucosal tonometry as a monitoring method in cardiac anesthesia. Empirical findings on the postoperative outcome under various volume controls].
Several studies documented higher complication rates after cardiac surgery in patients with splanchnic hypoperfusion. Although it is prone to errors, gastric tonometry probably is the method of choice for detecting splanchnic hypoperfusion. While there are many reasons for splanchnic hypoperfusion, low cardiac output because of hypovolemia is one of the important ones in cardiac surgery. Thereby endogenous vasoactive substances, such as angiotensin II and the kinins, might be of special interest. ⋯ Splanchnic hypoperfusion in cardiac surgery probably correlates with hypovolemia and therefore leads to vasoconstriction, wich is shown in higher expression of angiotensin II and lower of bradykinin. Gastric mucosal tonometry in cardiac surgery probably detects hypovolemia and therefore predicts haemodynamic instability. Therefore gastric mucosal tonometry could probably be used as a therapeutical sign for a sufficient cardiac output and therefore for tissue oxygenation in general.