Der Anaesthesist
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Case Reports
[Acute obstruction of an anesthetic gas evacuation system. Ventilation with a Servo Ventilator 900D].
During aorto-coronary bypass surgery acute expiratory airway obstruction occurred in two patients during controlled ventilation with a Servo D ventilator (Siemens Elema) in combination with a Servo EVAC 180 gas evacuation system. In this system expiratory volume passes from the ventilator to the reservoir bag. ⋯ We observed an increase in mean expiratory and inspiratory airway pressure above 40 mmHg due to blockage of the expiratory gas outlet by external lateral dislocation of the valve spring. In conclusion, while free mobility of the valve spring within the hanging Evac bag has to be ascertained at all times for safe application of the EVAC 180 system, the manufacturer should provide some appropriate mechanical shelter around the bag.
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We measured pulmonary elimination of carbon dioxide (VCO2), end-tidal and arterial CO2 tensions (PETCO2, PaCO2), deadspace ventilation (VD/VT), and arterial oxygen tension (PaO2) using a Siemens 930 CO2 analyzer incorporated into a servoventilator and arterial blood gas analyses, respectively, in 31 patients undergoing laparoscopic cholecystectomy with a median duration of pneumoperitoneum (PP) of 60 min. ⋯ During PP, CO2 is reabsorbed from the peritoneal cavity. During the initial unstable phase with rising PaCO2, reabsorption of CO2 is the sum of increased pulmonary elimination of CO2 above baseline and uptake of CO2 into gas stores of the body. We estimated CO2 reabsorption to be on the order of 70 ml/min during the first 30 min of PP. During the later, stable phase, reabsorption of CO2 equals increased pulmonary elimination of CO2 above baseline and was estimated to be in the order of 90 ml/min in 10 patients with 30-75 min of PP (hatched area in Fig. 2). PET-CO2 corresponded well with PaCO2 in these patients. VD/VT and arterial oxygenation did not change significantly with institution or during the course of PP. Monitoring VCO2 probably is a useful aid in the early detection of CO2 emphysema (Fig. 6).
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Simulators and training devices are used extensively by educators in 'high-tech' occupations, especially those requiring an understanding of complex systems and co-ordinated psychomotor skills. Because of advances in computer technology, anaesthetised patients can now be realistically simulated. This paper describes several training devices and a simulator currently being employed in the training of anaesthesia personnel at the University of Florida. ⋯ Exercises with the simulator are supported by sessions on a number of training devices. These present theoretical and practical interactive courses on the anaesthesia machine and on monitors. An extensive system, for example, introduces the student to the physics and clinical application of transoesophageal echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Fiberoptic intubation and stress].
Nasotracheal intubation of the trachea by means of fiberoptic endoscopy is an accepted approach to difficult airways. The associated avoidance of direct laryngoscopy may affect the stress response to nasotracheal intubation. We tested this hypothesis by means of a prospective, randomized, controlled clinical study. ⋯ Nasotracheal intubation does not provoke a major stress response, when performed in accordance with the protocol of this study. However, topical anaesthesia of the larynx, as well as the fiberendoscopic approach proved superior to control with respect to diastolic arterial pressure. We conclude that fiberoptic nasotracheal intubation, or laryngoscopy preceded by topical anaesthesia of the larynx may be useful in patients for whom an increase in rate pressure product would be undesirable.
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Randomized Controlled Trial Clinical Trial
[The incidence of postoperative pain on general surgical wards. Results of different evaluation procedures].
Knowledge of the incidence and significance of postoperative pain is essential for the establishment of effective pain treatment programmes. Detailed investigations on the incidence, severity and quality of postoperative pain from the surgeon's perspective are scarce in German hospitals. It was the aim of our study to investigate postoperative pain in general surgery under routine conditions. ⋯ CONCLUSIONS. We conclude from our results that patients perceive significant postoperative pain under current standardized pain treatment in our department. Effective programmes for pain relief should take account of the different patterns of pain after different operations, as identified in this study.