Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[A new indicator to determine the optimal PEEP (author's transl)].
To elucidate the optimal PEEP for respiratory treatment, respiratory and haemodynamic studies were performed on 12 normovolemic patients with ARDS for various levels of PEEP (PEEP = 0, 5, 10, 20 cm H2O). In this study, it became clear, that Suter's best PEEP (maximal O2 transport should be taken as a reference for optimal PEEP) cannot be used in practice because O2 transport is usually maximal in ZEEP (PEEP=0) and changes with the alteration of FIO2. We propose "intrapulmonary nonshunt flow ((Qt-Qs)" as a new indicator to determine the optimal PEEP. The level of PEEP to achieve the maximal intrapulmonary non-shunt flow must be such that the decrease in intrapulmonary shunt flow is attained with minimal decrease of cardiac output.
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The influence of pressure swings on the output of Dräger Vapor, Dräger Vapor 19, Cyprane Fluotec Mark 2, Cyprane Fluotec Mark 3 and Ohio halothane vaporizers was investigated. It is shown that significant deviations from the dial setting occur with all vaporizers if the swings are large enough. ⋯ The results indicate that swings, occurring during assisted or controlled intermittent positive pressure ventilation, can induce significant deviations at low carrier flow rates. The frequency and in-/expiration time ratio are relatively of minor importance.
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A 51 years old patient underwent 3 urological operations within a short space of time. The anaesthetic procedures (NLA and spinal anaesthesia) caused a rise of temperature, hyperventilation and tremor, suggesting a malignant hyperthermia. ⋯ In the daughter, some "whorled fibres" and single fibre necrosis, interpreted as signs of myopathy, were detected. The clinical syndrome of the father and the histological results of the daughter point out to the possibility that in this family a predisposition to malignant hyperthermia is present.
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A 13 year old girl who had suffered from an abortive form of malignant hyperthermia during tonsillectomy eight years before was scheduled for orthopaedic surgery. Dantrolene sodium, 3 mg/kg orally, was given prophylactically the day before surgery; preanaesthetic medication consisted of Thalamonal, a fixed combination of droperidol and fentanyl; anaesthesia was induced with methohexitone and maintained as neurolept anaesthesia with fentanyl and droperidol; tubocurarine was administered for tracheal intubation and intraoperative neuromuscular blockade. Using this anaesthetic regimen no adverse reaction was triggered.