Der Anaesthesist
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Comparative Study
[Narcotic gas burden of personnel in pediatric anesthesia].
To assess the occupational exposure of the anaesthetist to anaesthetic gases, a total of 1 German and 25 Swiss hospitals were investigated. A Brüel & Kjaer Type 1302 multi-gas monitor was used to measure concentrations of nitrous oxide and halogenated anaesthetic agents in the anaesthetist's breathing zone. Measurements were performed during 114 general anaesthetic, 55 of which were in patients under 11 years of age. In these 55 patients, the influence of various factors on the exposure (time-weighted average concentrations) was estimated by comparing different data groups. The efficiency of the applied scavenging equipment was examined by surveying the exhalation valve with a leak detector (type TIF 5600, TIF Instruments, Miami). ⋯ The exposure levels of anaesthetic gases are generally higher during anaesthesia in children up to 10 years of age than in older patients. Nevertheless, the measurements showed that exposure during paediatric anaesthesia can be kept below the recommended limit (8-h TWA in Switzerland) of 100 ppm nitrous oxide and 5 ppm halothane or 10 ppm enflurane or isoflurane. Causes of high exposures were particularly high fresh gas flows often applied without scavenging or together with inefficient scavenging devices and the high part of mask anaesthesia and inhalation induction with a loosely held mask. To achieve an effective reduction of occupational exposure, well-adjusted and maintained scavenging systems and low-leakage work practices are of primary importance. As leakage can never be completely avoided, a ventilation rate of at least ten air changes per h should be maintained in operating rooms and rooms where anaesthesia is induced to keep down concentrations of waste anaesthetic gases. High exposure during mask anaesthesia and inhalation induction can be prevented by further measures. Using a LMA instead of a standard mask reduces the exposure to the same level as endotracheal intubation.
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The authors report a tracheal rupture in a 34-year-old patient who was primarily intubated following generalised seizures and loss of consciousness (Rüsch endotracheal tube). Some hours later, she developed high ventilatory airway pressures and subcutaneous and mediastinal emphysema were noted. Reintubation with a high-volume, low-pressure endotracheal tube was planned when it was noted that the ballon of the Rüsch tube was grossly overinflated. ⋯ To maintain low airway pressures post-operatively, she remained sedated for 2 days and received a muscle relaxant to permit pressure-controlled ventilation. In this case, it can be concluded that excessive inflation of the endotracheal tube cuff resulted in the tracheal rupture. Other possible causes and results of tracheal rupture are discussed.
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By measuring pulse rate (PR), blood pressure (BP), electrical integral skin resistance (SR), and skin surface temperature in different areas, the activity of the sympathetic nerves in spinal anaesthetics of different levels was evaluated. It was found that the sympathetic subsystems for vasomotor and sudomotor activity have their own innervation and that the functionally different effectors also manifest different deficiency reactions in low- and medium-level spinal anaesthesia. Functional sympathetic innervation, however, is unimportant after high sensory spread of spinal anaesthesia. ⋯ Subsequently, hand temperature increases, and finally bradycardia and hypotension occur. The functional reaction of sympathetic activity is indicated by correlation of the vasomotor and sudomotor activities in high and low spinal anaesthesia. Failure of sudomotor activity can be observed on average at least 3 min prior to an increase in acral temperature and 9 min at the hands in cases of high spinal anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)