Der Anaesthesist
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Thermodilution measurements of cardiac output (CO) by means of Swan-Ganz catheters, in a strict sense, represent pulmonary arterial blood flow (PBF). In principle, this is also true in the presence of intracardiac left-to-right shunts due to atrial or ventricular septal defects. However, early recirculation of indicator may give rise to serious methodological problems in these cases. ⋯ PBF at extremely high shunt ratios, however, cannot be assessed by monoexponential extrapolation in principle (Fig. 6). Insufficient elimination of indicator recirculation resulted in flow values that closely resembled systemic rather than PBF. This finding is in accordance with a mathematical analysis of the underlying Steward-Hamilton equation if an infinite number of recirculations would be
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We report two cases of compartment syndrome of the lower leg that occurred in male patients aged 62 and 57 years, respectively, after 10 and 12-h urological surgery in the lithotomy position. During sedation and mechanical ventilation creatine kinase (CK) activity of more than 8,000 U/l was found in both patients. After extubation, clinical symptoms of the compartment syndrome were found. ⋯ The deep veins of the legs should be checked by phlebography. In cases of verified compartment syndrome, early fasciotomy is the best choice of therapy, because neuromuscular defects are known to be irreversible after 12 to 24 h. Enforced diuresis is recommended in order to avoid renal complications.