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
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
Case Reports[An anaphylactic reaction under anesthesia due to a combined latex and ethylene oxide allergy].
There is an increasing number of reports on anaphylactic reactions due to latex. We report on a 9-year-old boy who developed anaphylaxis shortly after induction of anaesthesia due to a combined latex and ethylene oxide allergy. Patients with multiple medical treatment and those with atopy seem to be at risk.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1993
[Mid-latency auditory evoked potentials during increasing doses of fentanyl].
Intraoperative awareness, and especially the perception of auditory stimuli occur occasionally under general anaesthesia with high-dose opioids. Mid-latency auditory evoked potentials (MLAEP) reflect the primary cortical processing of auditory stimuli. Hence, we studied the effects of fentanyl on MLAEP. ⋯ MLAEP and especially the primary cortical potentials Na, Pa, Nb did not change markedly in amplitude or latency during high-dose fentanyl analgesia. There is no dose-dependent effect of fentanyl on MLAEP as it can be observed under volatile anaesthetics (isoflurane, enflurane). The primary cortical processing of auditory stimuli can be completely blocked by volatile anaesthetics, but is still preserved under highest doses of fentanyl. This may be seen in connection with cases of awareness and perception of auditory stimuli during high-dose fentanyl analgesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1993
Review[Quantifying pathological disorders of consciousness. Reliability criteria, aims, feasibility].
Within a survey of coma scales we distinguish scales of clinical findings (Glasgow Coma Scale [GCS], Glasgow Liège Scale [GLS], Innsbruck Coma Scale [ICS], Comprehensive Level of Consciousness Scale [CLOCS]), grading tests (Vigilance Scale [VS], Funktionspsychose-Skala-B [FPBS-B]) and level-scales (Reaction-Level-Scale [RLS-85], Munich Coma Scale [MCS]). With regard to the purpose we differentiate a classification of depth, the prediction of prognosis and the monitoring of changes. For the purpose of classification of depth, the RLS-85 because of its superior objectivity is preferable, but the GCS is of comparable validity and more widely used. ⋯ The ICS is not widely used and the prognostic validity has not been proven to the same extent. The Glasgow-Cologne-List could be amplified for the less severe disturbances of consciousness according to Price (32,33), and for the lower levels according to the GLS (2,3,4). In both cases the expense is slightly higher.(ABSTRACT TRUNCATED AT 250 WORDS)