Der Anaesthesist
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Following anaesthesia with halothane and succinylcholine, a 56-year-old patient relapsed into unconsciousness which was accompanied by an increase of body temperature to 42 degrees C and further symptoms indicative of malignant hyperpyrexia (MH). Although a diagnosis of MH could not be established, during subsequent anaesthesia, the patient was treated as an individual susceptible to MH. The problems of this policy and the need to elucidate the susceptibility to MH are discussed with reference to this case.
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Accidental thermal damage in case of explosion and fire caused by laser-surgery is a well-known problem and still not solved. A combination of laser beam, oxygen and inflammable substances are only one aspect. ⋯ An incidental observation during one case of endotracheal tube-fire led to some fundamental considerations. With a modified PEEP-ventilation hazard can not be prevented, but limited in its complications.
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A new noninvasive cardiac output (CO) computer ("NCCOM 3") based on the bioimpedance principle was compared to a CO computer based on standard thermodilution measurements. Simultaneous measurements were made on dogs who were ventilated with or without positive end expiratory pressure (PEEP). There was no correlation of cardiac output measurements with the two methods (r = 0.10, n = 60). ⋯ These differences were statistically significant. We conclude that the NCCOM 3 cannot at present replace the invasive standard methods of CO measurement in ventilated patients. A lack of differentiation of circulatory effects, thoracic gas volume, and intrathoracic fluid content is the most likely cause of the discrepancies seen.