Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
Review[The role of mixed venous oxygen saturation in perioperative monitoring and therapy. A critical stock taking].
Since mixed venous oxygen saturation (SvO2) depends on O2-supply and O2-consumption, its measurement is said to indicate tissue O2-balance and to be suitable for ensuring tissue oxygenation in critically ill patients. Blood for SvO2 determinations should be drawn exclusively from the pulmonary artery, because mixing of systemic venous blood is incomplete in the right atrium and ventricle. SvO2 can be determined in vitro and in vivo. ⋯ Central venous oxygen saturation may indicate directional changes of the SvO2, but does not estimate the real SvO2-value. The hypothesis that continuous SvO2 measurements improve prognosis or lower treatment costs has not yet been confirmed. Measurements of mixed venous oxygen saturation may improve monitoring and treatment of critically ill patients in selected cases; however, these measurements are not suitable to indicate reliably the status of tissue oxygenation under all conditions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
Randomized Controlled Trial Comparative Study Clinical Trial[The hemodynamic effects of atracurium in geriatric patients during intravenous anesthesia using propofol].
Neuromuscular blocking drugs may produce cardiovascular effects by virtue of drug-induced release of histamine or other vasoactive substances from circulating mast cells, effects at cardiac muscarinic receptors or effects at nicotinic receptors at autonomic ganglia. These haemodynamic reactions may be more pronounced in elderly patients, since cardiovascular compensating mechanisms are attenuated with advancing age. The present study was designed to investigate the cardiovascular effects of atracurium with special regard to the reactions in younger adults and in elderly patients. ⋯ Since the results of the present study suggest that haemodynamic reactions in younger adults and in the elderly are rare, atracurium can be recommended for neuromuscular blockade in elderly patients under propofol anaesthesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
Case Reports[An anaphylactic shock reaction caused by latex from medical protective gloves].
In case of IgE-mediated latex allergy, the person wearing medical rubber gloves as well as the patient getting in contact with the gloves' outside may be affected. This is illustrated by the present case reports on two atopic young women. The first patient repeatedly underwent laparotomies and finally, 50 minutes after the onset of another operation, suffered an anaphylactic shock reaction due to transperitoneal latex resorption. ⋯ Latex prick testing in this patient resulted in an anaphylactic shock reaction. With regard to these observations the general aspects of intraoperative allergen exposition and safety of latex skin testing are discussed. Recommendations are given for a) the latex test procedure in case of anamnestic suspicion of high-degree sensitisation, b) the issuing of a latex allergy pass, and c) the use of latex-free synthetic gloves.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
Biography Historical Article[Arthur Läwen--a pioneer of modern anesthetic techniques].
The development of modern local anaesthetic techniques is connected with the name of Arthur Läwen. At the turn of this century, he started his surgical training with Heinrich Braun, who had performed a lot of research with various local anaesthetic methods and who was renowned world-wide as an authority for his contributions. It is not surprising that a main topic of Läwen's research was the development of new local anaesthetic regimes. ⋯ The further development of new techniques for the differential diagnosis of various illnesses must also be mentioned. A remarkable step towards a modern anaesthesia concept was the administration of curare for muscle relaxation in operative surgery. Another evidence of his foresight are his contributions in the development of an electrically driven apparatus to overcome respiratory failure "Läwen was in many ways a man before his time:" This appraisal by a surgeon colleague is true even today for several of his anaesthesia-related contributions, which are still part of the armamentarium of modern anaesthetic methods.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Single-shot spinal anesthesia versus continuous spinal anesthesia using the CoSPAN catheter].
We compared conventional single-shot spinal anaesthesia (SS) with continuous spinal anaesthesia (CS) in a randomised prospective study. ⋯ Fractionated injection of the local anesthetic via a spinal catheter was more precise in achieving the desired maximum cephalad spread than SS. The CS group revealed a significantly more stable blood pressure than the SS group. The use of a short-acting local anesthetic for CS provided an earlier postoperative return of motor function of the legs. Postspinal headache appears not to be a clinically relevant problem when 28-gauge spinal catheters are used.