Der Anaesthesist
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Erythropoietin therapy during frequent autologous blood donations. Dose-finding study].
Avoidance of homologous blood products and patients' demand for preoperative autologous blood donation programs are increasing. As many of these patients are older, with a compromised cardiovascular system and a slow response of the erythropoietic system when anemia occurs, the feasibility and benefit of autologous blood donation is often limited. Augmentation of preoperative blood donation by therapy with recombinant human erythropoietin (rHuEPO) has been described in animal models and in patients. ⋯ No such disturbances were observed in the present study. CONCLUSION. rHuEPO ameliorates the preoperative decrease of haemoglobin and haematocrit values due to autologous blood donations in a dose-related fashion. The individually adjusted dosage of rHuEPO and iron supplementation merits further investigation.
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Randomized Controlled Trial Clinical Trial
[The application of n-acetylcysteine as an antioxidant and mucolytic in mechanical ventilation in intensive care patients. A prospective, randomized, placebo-controlled, double-blind study].
Oxygen radicals and oxygen radial mediators are thought to be important components in the development of acute lung injury, sepsis, and multiple organ failure. Injured patients, patients with pulmonary diseases, and multiple trauma patients also showed an elevated lipid peroxidation, indicating increased oxidant stress. N-Acetylcysteine (NAC) has been used as an antioxidant in a wide variety of experiments. ⋯ CONCLUSION. The present data do not support routine use of NAC in ventilated patients, either as an antioxidant or as a mucolytic agent. Intravenous administration of 3 g NAC/day had no clinically relevant effect on glutathione levels, lipid peroxidation products, tracheobronchial mucus, and clinical condition.
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Oxygen (O2) for clinical application is generally provided from either a central gas supply via a hospital pipeline system or is delivered to the working place in cylinders as compressed gas. An alternative source is the one-site generation of O2 from air using O2 concentrators based on molecular sieve technology. Whereas O2 concentrators for anaesthesia in remote areas or underdeveloped countries are wide-spread, in Germany their use is common in neither hospitals nor anaesthesiological practice. ⋯ For the future, the use of O2 concentrators for anaesthesia seems to be a practicable alternative to compressed O2 from cylinders. The main application could be in small operating units or anaesthesia practices. The method is safe and without additional risk of hypoxia, even in rebreathing systems and closed circuits, when the O2 concentration in the inspired gas is measured.
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To demonstrate the safety of autologous blood donation in an obstetric practice. ⋯ Our experience demonstrates that autologous blood donation is a safe practice in the setting of obstetrics, when the indications and contraindications are considered. Further studies in larger patient populations are necessary to expand or restrict the indications for autologous transfusion in obstetrics.
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Oesophageal malposition of an endotracheal tube is among the leading causes of anaesthesia incidents. While clinical manoeuvres for detection of tube malposition are unreliable, monitoring (i.e. capnography) can prevent such incidents. The problem is particularly important in prehospital care, where capnography is not (yet) widely available. ⋯ These devices are useful for preclinical practice. According to the literature and our experience, the ODD is superior for the initial control of tube position, especially in cardiac arrest. Capnometry is needed, however, for continuous control of ventilation.