Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Aug 1991
Case Reports[Intubation problems of anesthesia in otorhinolaryngology].
Many pathological changes in pharynx and larynx can cause problems in endotracheal intubation. Their preliminary signs and symptoms are often uncharacteristic. Thus prophylaxis is not always possible. ⋯ The photos were taken during endoscopic examinations in an ENT-clinic. The method of anaesthesia used in these cases is described, as well as prophylactic measures to be taken, if a difficult intubation may be expected. Finally, the procedure in case of an unexpected critical intubation is discussed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1991
Comparative Study[Carbomonoxyhemoglobin and methemoglobin in patients with and without a smoking history during ambulatory anesthesia. Consequences for the use of pulse oximetry].
Carboxyhemoglobin (COHb) and methemoglobin (MetHb) in venous blood were determined by oximetry in 1000 non-hospitalised preoperative patients. 370 of them were smokers (S), 630 non-smokers (NS). In addition, in five S we compared the oxygen saturation measured by pulse oximetry (SaO2, p) with that measured by in vitro oximetry (SaO2) and that calculated with reference to COHb (SaO2,korr). MetHb (0.66 +/- 0.21%, mean +/- standard deviation) was found to be of no relevance. ⋯ We conclude that there is an indication for in vitro oximetry in non hospitalised smokers or cases of unknown smoking history. If oximetry is not available, both a reduction of O2-binding hemoglobin and an overestimation of SaO2 by pulse oximetry in an order of ten per cent should be taken into account. To compensate for dyshemoglobin fractions, pulse oximetry using more than two wavelengths is desirable.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1991
Review[Anesthesia-related morbidity and mortality].
Anesthesia-related mortality rate is estimated at 1 death per 10,000 procedures. Four general failures in anesthesia management are responsible for the majority of deaths: difficult intubation, aspiration, insufficient ventilation, and insufficient volume substitution. More than half of all critical incidents are considered preventable--by better patient preparation, better monitoring or increased vigilance. ⋯ In addition, 10% of all patients experience intra- or postoperative complications such as arrhythmia, hypo- or hypertension. Several patient-related factors, such as age or the number of coexisting diseases, as well as management factors, such as choice of anesthetic technique or the experience of the anesthesiologist, are important determinants of morbidity and mortality. This review gives a comprehensive summary of recent results in risk-analysis and the study of critical incidents in anesthesia.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1991
Case Reports[Artificial respiration in the prone position in a case of acute respiratory distress syndrome].
A patient is presented in whom an acute respiratory distress syndrome (ARDS) developed after severe lung contusion. Exchange of gas was markedly restricted under aggressive respiration (FiO2 = 1.0, PEEP = 10 mmHg, breathing time quotient = 0.5, respiratory minute volume = 16 litres; gas exchange values: PaO2 = 67 mmHg, PaCO2 = 45 mmHg, PA-aO2 = 461 mmHg). After control of the computed tomogram of the lungs showed marked densifications in those parts of the lung that are lower most by gravitation according to the positioning of the patient at a particular time the patient was ventilated in ventricumbent (prone) position for 60 hours. ⋯ Five days later the patient could be extubated. Respiration in ventricumbent (prone) position may considerably improve oxygenation by perfusion of well-ventilated regions of the lung that are lower-most by gravitation according to the relative positioning of the patient. Besides regions not well ventilated or not ventilated at all (according to the patient's position) may be better ventilated or re-opened and made accessible to ventilation by this method.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 1991
[Pulse oximetry monitoring of postanesthetic transportation of ophthalmic surgery patients: risk of hypoxemia despite pre-oxygenation].
40 adult patients, ASA class I-III, were studied with regard to their arterial oxygen saturation during transportation from the operating room to the recovery room, following ophthalmic surgery under general anaesthesia. Before transportation the patients were breathing oxygen spontaneously for 6 min.; during transportation they were breathing air. The time for the transport from the operating room to the recovery room was between two and eight minutes. Hypoxaemia (SaO2 85-90%) was observed in 18 cases, severe hypoxaemia (SaO2 less than or equal to 85%) in 5 cases.