Der Anaesthesist
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After successful rescue from drowning there may develop a situation which is called secondary drowning, resulting in acute respiratory distress characterized by interstitial pulmonary oedema, hypoxaemia, hypercapnia and acidosis during drowning, direct alteration of the alveolar membrane by aspirated water and particulate matters and a volume overloading by adsorption and--not seldom--inept therapy. This situation requires mechanical ventilation and forced diuresis, combined with high doses of steroids, antibiotics and digitalis. ⋯ After development of acute respiratory distress only the immediate utilization of the therapeutic modalities of an intensive care may result in a satisfactory outcome. Four months later our patient had normal pulmonary function except for a moderate reduction of compliance.
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The heart rate of anaesthesiologists under defined physical and psychological stress as well as during normal anaesthetic practice was studied. An acceleration of heart rate during induction and management of anaesthesia did not occur except in the presence of complicating circumstances. A phone call or a beeper alarm led to a rather ergotropic heart rate reaction (increase of 21%), especially when sleep was interrupted (increase of 75%). ⋯ However an increasing tolerance was seen with growing experience. Physical and psychological stress during the anaesthesiologist's work could be differentiated by means of heart rate except in some single observations. In the presence of both stressing factors the heart rate seems to be determined by the motor effort required.