Der Anaesthesist
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Case Reports
[Life-threatening postoperative angioedema following treatment with an angiotensin converting enzyme inhibitor].
Angio-oedema is a recognised complication of angiotensin converting enzyme (ACE) inhibitor therapy, occurring in 0.1% to 0.5% of patients taking captopril, enalapril, or lisinopril. This is the first report of severe angio-oedema complicating therapy with quinapril, a new, long-acting drug. CASE REPORT. ⋯ Despite a significant increase in angio-oedema associated with the use of long-acting ACE-inhibitors, there appears to be a lack of familiarity among anaesthesiologist and other emergency physicians concerning this adverse effect. Withdrawal of the drug is the only effective treatment. High-dose steroids may be helpful, but if there is beginning dyspnoea or stridor, early endoscopically controlled intubation or emergency tracheostomy is essential to avoid hypoxaemia and death, as has occurred in the past.
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Increasing numbers of monitors at the anaesthesiologist's workplace, providing more than 20 different parameters of the patient's condition, have already made it impossible to record all the values in a handwritten form. Consequently, this most common method of record-keeping must be incomplete and inaccurate. In recent years computerised data-acquisition systems have been introduced into clinical practice in order to produce more reliable records. ⋯ Based on more than 30,000 values for each parameter, the incidence of artifacts was 3%-7%. However, only 0.1%-0.5% of the artifacts could not be eliminated by the filter. The method described here provided acceptable graphic printouts of the most important haemodynamic parameters (Figs. 1b and 2b) and would also be suitable to serve as an input filter for automatically running anaesthesia data-examination processes, which are currently being developed in our clinic.
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Comment Letter Biography Historical Article
A question of priority: who introduced the CO2 absorption method with circle breathing into anaesthesia practice?