Der Anaesthesist
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Modern medicine has succeeded in achieving enormous technical developments. One recent highlight has been the introduction of postmortem organ transplantation. At the same time, serious objections have been raised concerning the radical changes in the cultural conception of the inviolable body. ⋯ The beneficiary of the treatment is not the donor, but another person, the recipient. The concept of human dignity does not allow the use of a person for purposes other than the ones he/she consents to, as Immanual Kant stated. Although the human corpse is not a person in the full sense, even if it is protected by the thought of respect for the former person, the life-interest of the organ recipient had to be considered legitimate.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Ondansetron as prophylaxis for postoperative nausea and vomiting. A prospective randomized double-blind comparative study with droperidol].
Ondansetron, a selective 5-HT3 receptor antagonist, has recently been shown, in a dose of 8 mg, to be superior to 1.25 mg droperidol in preventing postoperative vomiting. There are indications that a dose of 4 mg of ondansetron may be just as effective in reducing postoperative nausea and vomiting as a dose of 8 mg. The aim of this study was to evaluate the efficacy and the adverse effects of 4 mg ondansetron in the prevention of postoperative nausea and vomiting compared to droperidol in patients undergoing surgery with inhalation anaesthesia supplemented with alfentanil. ⋯ CONCLUSION. Our results show that for the prevention of postoperative nausea and vomiting 4 mg of Ondansetron was inferior to 1.25 mg of droperidol. The drugs were given intravenously prior to general anaesthesia for minor gynaecological surgery with nitrous oxide and enflurane in oxygen supplemented with small boluses of alfentanil.
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A 34-year-old male (190 cm/100 kg) was scheduled for surgery of the nasal septum. He had had uneventful anaesthesia for appendicectomy 14 years earlier: following 600 mg thiopentone, 180 mg suxamethonium and up to 2 vol.% halothane for 20 min had been used and no symptoms of malignant hyperthermia (MH) were recorded. Following oral premedication with 2 mg flunitrazepam at 7.00 a.m. anaesthesia was induced with a priming dose of atracurium at 8.45 a.m. followed by 0.2 mg fentanyl, 500 mg thiopentone, and 100 mg suxamethonium. Endotracheal intubation was accomplished easily, and the patient was ventilated manually in a semi-closed circle system until spontaneous ventilation resumed. Enflurane (1.5% for 5 min, 1.0% for 10 min, and 0.8% until the diagnosis of MH was suspected) was given in 33% O2/66% N2O. Seventy minutes after induction it was noted that the spontaneous respiratory rate and minute volume had risen continuously from 10/min and 6 l/min, respectively, to 20/min and 12 l/min. Attempts at deepening anaesthesia with repeated doses of fentanyl up to a total dose of 0.95 mg failed to reduce the hyperventilation. In spite of a high fresh gas flow of 6 l/min and assisted manual ventilation, the FIO2 started to fall from 0.34 to 0.28 at 10:20 a.m. The O2/N2O ratio was changed to 1:1, but the FIO2 remained at 0.3. MH was suspected, enflurane was discontinued, and an arterial blood gas analysis was done (Table 2). When marked acidosis and hypercarbia were found, dantrolene 2.5 mg/kg was given, the operation was terminated, and the patient's trachea was extubated and he was monitored closely in the intensive care unit for 24 h. Vital signs were stable (Table 3) and no further complications were observed. The patient did not mention pain or uneasiness postoperatively. About 6 months later, a muscle biopsy was done according to the European MH Protocol and the patient was found to be MHEh. ⋯ It is concluded that the hypercarbia and mixed acidosis were caused by hypermetabolism. A thorough postoperative examination by an internist did not reveal any thyroid, pulmonary, endocrine, or circulatory reason for our intra- and postoperative findings. Iatrogenic factors like superficial anaesthesia or systemic side effects of adrenaline admixture to local anaesthetics can cause hypermetabolism without striking clinical signs, but they do not cause mixed acidosis lasting longer than 6 h (Table 2). The most suitable explanation in this case is an abortive form of MH. Even patients who are MHS positive on muscle biopsy do not necessarily go through an MH crisis every time they have stress or undergo anaesthesia. The diagnosis of a fulminant MH crisis is a clinical one. Therefore, we are aware that there is no direct scientific ev
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Comparative Study
[The effect of changes in lung compliance on ventilation in newborns. Results of animal experiments with two different respirators].
In most ventilators used in anaesthesia tidal volume delivered during mechanical ventilation is different from the tidal volume preset at the respirator on the basis of respirator and circuit compliance and gas compression during inspiration. The error in ventilation due to the compressed volume is especially significant clinically when the tidal volume is very small or when the airway pressure is very high. In newborns and neonates in particular, decreasing lung compliance during a surgical procedure may contribute to marked hypoventilation. ⋯ This reflected by an increase in peak inspiratory pressure and can be corrected by increasing the respiratory rate. In contrast, the CICERO is able to preserve ventilation by an internal correction for gas compression, but it does not guarantee normoventilation in all cases. In neither group does the end-tidal PCO2 reflect the true ventilation during decreasing lung compliance, so that arterial blood gas analysis seems to be mandatory for the diagnosis of hypercapnia in such situations.