Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1996
Review[Is infection and septic shock caused by a global oxygen deficiency? An overview in 2 parts. 1: Infection and correlation between DO2 and VO2].
A global hypoxia resulting in an oxygen debt is assumed to be present in patients who suffer from the different stages and degrees of sepsis including septic shock and ARDS. As a consequence, the therapeutic concept of optimal values for cardiac output and oxygen delivery for these patients was proposed. This article reviews the literature with the objective of determining whether investigations dealing with oxygen delivery and consumption and with the plasma lactate concentration support the idea of the global hypoxia in septic patients. ⋯ The dogmatic proposal to increase cardiac output and oxygen delivery to certain levels cannot be sustained. However, regional hypoperfusion (e.g., of the splanchnic vascular bed) cannot be excluded. New approaches like gastric mucosal tonometry, measurement of splanchnic blood flow, and determination of regional metabolism are currently under investigation.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1996
[Attempt at a definition of the individual anesthesia level by repetitive pain stimulation: correlation with EEG findings].
Previous studies using EEG for assessment of depth of anaesthesia correlate anaesthetic concentration with the anaesthetic stage. This procedure neglects the well known effect of individual different susceptibility to anaesthetics. Thus, patients receiving similar concentrations of anaesthetics may not necessarily be at the same level of "anaesthetic depth". The aim of this study was to define an interindividual comparable level of anaesthesia by recording the autonomic cardiovascular reaction to a standardised painful stimulus (tetanic stimulus, 80 mA, 100 Hz). ⋯ This method to define individual depth of anaesthesia as described, results in more consistent EEG patterns and may be useful in relating EEG to depth of anaesthesia.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1996
Review[Circulating cerebral microembolisms. Detection with transcranial Doppler ultrasound].
Ischaemic stroke is predominantly caused by cerebral emboli which may originate from cardiac sources or atherosclerotic lesions of the cerebral arteries. The diagnosis is primarily based on clinical symptoms and may be confirmed by typical patterns in cranial computed tomography. Echocardiography, ultrasonography of the supraaortic vessels, and angiography are additional diagnostic tools and helpful in clarifying the pathogenesis. ⋯ The high number of patients after valve replacement showing up to 30 embolic signals per minute without suffering from neurologic symptoms raises the question whether continuous, predominantly gaseous microembolisation may cause cumulative brain damage. At present, the nature of emboli (gaseous vs. solid) cannot be easily identified by TCD in clinical settings. Future technical improvement of ultrasonic devices may solve this problem, since detection of solid rather than gaseous emboli seems more likely to be clinically relevant.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Differential administration of non-opioids in postoperative analgesia, I. Quantification of the analgesic effect of metamizole using patient-controlled analgesia].
The aim of this study was to investigate: 1. Whether the perioperative administration of metamizol causes a significant reduction in postoperative opioid requirements within the first 24 h after surgery. 2. The opioid-sparing effect after different types of operations. 3. Whether preoperative application of metamizol causes a significant reduction of the pain-score immediately after operation. ⋯ Perioperative administration of metamizol results in better pain relief and significantly lower buprenorphine requirements particularly after laparoscopic operations. To achieve a significant pain reduction immediately after the operation, the first dose should be applied before induction.