Der Anaesthesist
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Clinical Trial
[The effect of fresh-gas decoupling on respiratory volume. Draegar Sulla 808V anesthesia ventilator].
In order to perform accurate low-flow anaesthesia ventilation, it is desirable to avoid the influence of fresh gas flow (FGF) and inspiration duration (ID) on the resulting minute volume (MV). The Sulla 808V anaesthesia ventilator (Draeger, Luebeck, Germany) is originally not equipped with a fresh-gas decoupling (FGD) device. Therefore, changes of FGF and ID settings applied during controlled ventilation may lead to alterations of the resulting MV. Recently, a low-cost FGD device (Carbamed, Bern-Liebefeld, Switzerland) has been developed, which can be inserted into the circle system. We investigated the effect of this device on MV in the Sulla 808V anaesthesia apparatus. ⋯ The tested FGD device can easily be integrated into the circle system of conventional anaesthesia machines such as the Draeger Sulla 808V, and is available at a reasonable cost. It allows constant ventilation parameters to be maintained that remain unaffected by wide FGF and ID variations. With this FGD the performance of the ventilator can be improved considerably, and low-flow anaesthesia can be used more extensively.
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Neurogenic pulmonary edema (NPE) is a rare but always life-threatening complication in patients with central nervous system lesions. NPE is evident if patients shortly after cerebral lesions suddenly develop pulmonary edema and other causes of the symptoms, such as aspiration of gastric content, congestive heart failure and direct toxic exposure, are ruled out. ⋯ NPE is always a life-threatening symptom after increased ICP, where immediate therapeutic interventions are imperative. A rational therapeutic approach needs to be focused on decreasing ICP as primary goal. Additionally, attempts should be made to optimize body oxygenation, decrease pre- and afterload and increase myocardial contractility. Postictal patients suspicious for incipient ventilation problems must be admitted to hospital for further evaluation.