Der Anaesthesist
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In order to assess the significance of drug levels measured in clinical and forensic toxicology as well as for therapeutic drug monitoring (TDM), it is essential that good collections of data are readily available. For more than 400 frequently used drugs therapeutic and, if data were available, toxic and fatal plasma concentrations as well as elimination half-lives were compiled in a table including, e.g., hypnotics like barbiturates and benzodiazepines, neuroleptics, antidepressants, sedatives, analgesics, anti-inflammatory agents, antihistamines, anti-epileptics, beta-adrenergic antagonists, antibiotics (penicillins, cephalosporins, aminoglycosides, gyrase inhibitors), diuretics, calcium-channel blockers, cardiac glycosides, anti-arrhythmics, anti-asthmatics, angiotensin converting enzyme inhibitors, opioid agonists, and local anaesthetics. ⋯ The range of (or single) half-life values given for each drug are chosen to represent the terminal log-linear phase at most. In addition to the assessment of significance of drug levels for the therapeutic monitoring of patients, this list can assist the diagnostic assessment in cases of intoxication.
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Acute upper gastrointestinal bleeding in ICU patients has many possible causes: ulcer, adverse drug effects, gastric tube lesion, acute renal or liver failure, or stress-induced gastric mucosal lesion. Stress-induced gastric mucosal lesions typically are multiple superficial erosions, while ulcerations typically occur in patients with head trauma, neurosurgical operation or severe burns. Head trauma and neurosurgical patients are the only ones with increases gastric acid secretion; in general reduced acid secretion can be observed in ICU patients. ⋯ Active acid secretion depends on sufficient oxygen supply and mucosal ATP content. Hypotension and shock results in gastric mucosal ischaemia. These are the most important risk factors of stress bleeding.
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Comparative Study Clinical Trial
[Plethysmechanomyography (PMG). A simple method for monitoring muscle relaxation].
Ideal evaluation of neuromuscular blockade can be done by mechanical or electromyographical registration of muscle contractions evoked by ulnar nerve stimulation. Unfortunately, devices needed for such registration are expensive or complicated to set up, and thus are not often used for routine monitoring in anaesthesia. In this study, we describe a simple and low-priced method permitting intra- and postoperative monitoring of neuromuscular blocking agents. ⋯ Mechanomyography and EMG are well established methods of neuromuscular monitoring. Our data demonstrate that PMG provides a reliable measurement of neuromuscular transmission that correlates well with EMG. Since only materials of daily use in anaesthesia are needed, no substantial costs will arise when the plethysmographic method of measurement is used for routine anesthetic monitoring.
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Clinical Trial
[Axillary blockade of the brachial plexus. A prospective study of blockade success using electric nerve stimulation].
Axillary block is a common anesthetic technique for operations on the hand and forearm. In our hospital, with many trainees in anaesthesia, only 250-300 axillary blocks per year are performed by about 30 colleagues. This implies a small number of blocks for each anaesthetist. ⋯ Prior to injection of the local anaesthetic, the current for nerve stimulation should be reduced to < 0.5 mA. The time between the end of injection and the beginning of surgery should be no less than 30 min because complete sensory blockade can more often be achieved. The dose of mepivacaine should be no less than 6 mg/kg body weight.
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Posttraumatic cardiopulmonary resuscitation (CPR) is associated with a poor outcome. When evaluating the literature according to the Utstein method, there were only 2 survivors (0.18%) out of 1,135 CPR attempts after trauma (Table 1). Differences in the study populations and levels of prehospital trauma care led us to analyse the results of a physician-staffed prehospital trauma care system in Cologne. ⋯ Survival has to be regarded as an individual fate; the overall results are discouraging. Even though this study analyses the largest population of posttraumatic CPR ever published, prognostic factors could not be identified due to the few survivors. Nevertheless, the result does not justify general omission of CPR after trauma as: (1) prognostic factors for survival have not been identified thus far; and (2) no significant additional costs arise from posttraumatic CPR.