Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1992
Review[Acute respiratory failure--support of gas exchange using extracorporeal or implanted oxygenators--present status and future development].
In acute respiratory failure gas exchange can be supported or even maintained in an "alternative" way to mechanical ventilation using extracorporeal techniques (extracorporeal membrane oxygenation ECMO, extracorporeal CO2-removal ECCO2R), or intravenacaval oxygenators (IVOX). These techniques, which are currently in use in neonatology, pediatrics, and adult intensive care medicine, or techniques at present in clinical evaluation (IVOX), are reviewed with their indications, contraindications, differences, problems, worldwide results, and possible future applications.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1992
Biography Historical Article[Curare and its successors. A 50-year's evolution].
The introduction of curare into clinical anaesthesia by Griffith and Johnson in 1942 contributed to the termination of the era where anaesthesia was a reversible intoxication rather than the result of controlled drug action. Curare allowed general anaesthesia to be reduced to a lighter level, thereby conferring a significant safety factor to the patient. Both the shortage in supply of crude curare and its variable composition led the search for synthetic curare analogues conferring well defined pharmacodynamic and pharmacokinetic properties. ⋯ Researchers became aware that new muscle relaxants should be designed for larger volumes of distribution and more rapid biodegradation than those currently available. Concurrently, anaesthesia techniques had changed in a way to use intubation and mechanical ventilation as a routine procedure. The risk of intraoperative hypoventilation and hypoxemia was eliminated, yet, due to the lack of adequate monitoring techniques the slow recovery from curare, alcuronium or pancuronium neuromuscular blockade was hardly appreciated.(ABSTRACT TRUNCATED AT 400 WORDS)
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1992
[Initial experiences with rigid angled optical systems as intubation aids in difficult intubation].
Referring to a classification by Cormack, difficult laryngoscopy of Grade 3 (only the epiglottis or a part of it can be seen) was simulated in 16 patients by lowering the blade of the laryngoscope, so that the epiglottis was pushed down and thus covered up the vocal cords. The object of the study was to test whether a newly developed rigid endoscope is a useful tool during intubation in cases of laryngoscopical view Grade 3. ⋯ The tracheal tube was inserted into the trachea, under endoscopic control. With this new method, naso-tracheal intubation under endoscopic control in all 16 patients was successful, without affecting the pharynx and the vocal cords.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1992
Review[The scientific basis of cardiopulmonary and cerebral resuscitation].
A survey is given on the scientific background of cardiopulmonary-cerebral resuscitation, which supposedly will be the basis of all clinical practice in this field. Haemodynamic, respiratory, acid-base, and cerebral problems are discussed in detail. As for haemodynamics, the pathomechanisms of the conventional "heart pump" and the "thoracic pump" as background of the "New CPR" are compared, the flow being generated by a direct compression of the heart in the former and by a phasic increase of the intrathoracic pressure in the latter case. ⋯ Finally, open cardiac massage is no doubt superior to all the other indirect and closed methods of cardiac resuscitation. Defibrillators and heart-lung "thumpers" are then described, mentioning the improvements in respect of automatic and semi-automatic defibrillation and the progress made by developing flexible and individually adaptable types of "thumpers". On assessing the sympathicomimetic drugs, it is evident that epinephrine is the method of choice in the acute phase of resuscitation; the pure beta-adrenergics isoprenaline and orciprenaline are not used any more, whereas the alpha-mimetics, although acutely effective similar to epinephrine, cannot produce positive long-term effects; the combination of dobutamine and dopamine seems to be ideal for establishing stable haemodynamic situations following a successful acute reanimation procedure.(ABSTRACT TRUNCATED AT 250 WORDS)