Der Anaesthesist
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Prolonged endotracheal intubation may be complicated by tracheal wall lesions caused by the blocking cuff of the tube. This happens when the tracheal wall load exceeds the capillary perfusion pressure. It is therefore important to control this load. ⋯ In a model trachea we showed the significance of the tracheal wall pressure as approximated by an indirect measurement principle. Our investigations demonstrate that the examined indirect method provides a sufficient approximation of the tracheal wall load only if it is used with the new low pressure high volume cuffs. It fails if it is used with the customary high pressure low volume balloons.
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The action of dopamine was evaluated in 18 patients with cardiogenic shock after myocardial infarction, in 14 patients with heart failure and in 18 patients with low-output syndrome after cardiac surgery. In the patients with shock, dopamine increased significantly systolic arterial blood pressure, myocardial contractility, diuresis and sodium excretion. ⋯ In patients after cardiac surgery dopamine produced a significant increase of arterial blood pressure and diuresis with decrease of CVP. The clinical application of dopamine and the advantages of the use of dopamine combined with other catecholamines were discussed.
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The purpose of our investigations was to evaluate the influence of disturbed inspiratory gas distribution on postoperative hypoxemia in patients with abnormal lung function undergoing upper abdominal surgery. The lung function analyzer Hewlett-Packard 47402 A was used (Volume-time and flow-volume curves of forced expiration, single and multiple breath nitrogen washout tests with indices of ventilatory gas distribution). It was demonstrated that postoperative hypoxaemia in the undamaged lung is almost exclusively the result of augmented true right to left shunt. ⋯ In patients with borderline lung function this reduction of FRC postoperatively may limit surgical treatment. The management of pain is of great importance in these patients. Continuous epidural anaesthesia certainly produces the best results in this respect.