Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Prevention of intraoperative hypothermia in children].
Children are very sensible to the occurrence of intraoperative hypothermia (HT) (core temperature < or = 36.0 degrees C) during general anaesthesia because their regulation capacity is less effective than in adults and due to a large skin-surface area compared with their body mass. We compared the efficacy of different heating devices to prevent HT in children during surgery. ⋯ OR temperature seems to be a critical factor influencing heat loss. Increasing OR temperature and covering with cotton sheets was not effective in preventing the heat loss. Increasing room temperature in combination with aluminum sheets is one alternative to prevent HT. Our study shows that the use of a convective warming device prevents HT during a 2-hour surgery in young children even at a OR temperature of about 22 degrees C. In conclusion, in pediatric patients the use of a convective heating system proved to be an effective alternative to room heating.
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This review highlights the advantages of regional anaesthesia techniques, especially of epidural analgesia, for the management of postoperative and posttraumatic pain: excellent pain relief and a high degree of patient satisfaction, even compared to the gold standard of acute pain therapy, i.v. PCA with opioids. Further advantages of epidural analgesia (EA) are discussed, such as early recovery of gastrointestinal function, reduction of postoperative respiratory complications, lower incidence of myocardial ischema, better mobilisation, reduced risk of thromboembolism, lower incidence of chronic pain problems (such as phantom limb pain) etc. ⋯ Organisational structures (such as an acute pain service) and appropriate monitoring allow to continue EA with local anaesthetics and/or opioids on surgical wards. Recommendations are given for the monitoring of EA on surgical wards. Clear cut agreements should define the role of anaesthesiologists, surgeons and nurses in the management of patients treated with postoperative EA on surgical wards.
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Partial liquid ventilation (PLV) is a relatively new therapeutic approach to acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). The idea of combining the intrapulmonary application of an oxygen-carrying substance and positive pressure ventilation was introduced by Fuhrman in 1991 and originally called perfluorocarbon-associated gas exchange (PAGE). Nowadays, the technique is mostly known as partial liquid ventilation (PLV). ⋯ However, combination therapy is still experimental and further investigation is necessary to evaluate efficacy and potential risks. Many questions still exist which need to be answered by experimental as well as human pilot studies. Based on these studies, the results of ongoing human trials can be assessed properly and new multicenter trials can be planned effectively.
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Randomized Controlled Trial Clinical Trial
[Changes in fluid filtration capacity and blood flow after tourniquet in knee operations with spinal anesthesia].
An increased microvascular water permeability has been reported after ischemia/reperfusion both in animal models and in human studies. We studied the changes in fluid filtration capacity (FFK) after ischemia/reperfusion due to tourniquet in patients undergoing arthroscopy of the knee. ⋯ A tourniquet of < 1 hour does impair tissue oxygenation as indicated by the increase in lactate and the decrease in pH. The duration of the tourniquet was however to short to have caused sufficient microvascular damage result in a more pronounced increase in fluid filtration capacity.