Der Anaesthesist
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Malignant hyperthermia (MH) is an autosomal dominantly inherited disorder, triggered in susceptible individuals by inhalation anesthetics and depolarizing muscle relaxants such as succinylcholine. Because of its high sensitivity (97-99%) and specificity (93.6%) as well as the genetic heterogeneity of MH disorder, the in vitro contracture test (IVCT) following the European-MH-Group is considered to be the "Gold Standard" for phenotypical determination of predisposed patients. On the other hand mutations in the skeletal muscle ryanodine receptor gene (RYR1) are tightly linked with MH susceptibility. After detecting a C1840T-mutation (Arg614Cys) in the RYR1 gene in one individual of a large MH family, we searched for this mutation in the remaining family members and determined the concordance with IVCT. ⋯ Based on results of IVCT the identification of a MH associated mutation in a MH-family can make and support a correct MH diagnosis and can resolve MHE findings.
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The objective of this review is to describe which hygiene measures are appropriate and necessary in anaesthesia and the ICU and which are not, whereby unnecessary hygiene measures are those which are not substantiated by scientific data. The most effective single infection control measure is still hand disinfection between patient contacts. Unnecessary measures include routine sampling of environmental surfaces, disinfecting the floor in the ICU, protective gowns for visitors, so called in-line filters in the infusion system etc. Ventilator tubes only need to be exchanged once a week, even when no HMEs are used.
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Randomized Controlled Trial Clinical Trial
[The effect of different priming doses on the pharmacodynamics of cisatracurium].
The aim of the study was to evaluate the effect of two different priming regimen on the onset time of 100 micrograms/kg cisatracurium, when compared to bolus administration. ⋯ Our data indicate that the "priming principle" is an appropriate technique to shorten the onset time of cisatracurium. To achieve a maximum effect the priming combination of 15 micrograms/kg cisatracurium followed after 4 min by 85 micrograms/kg cisatracurium is recommended.
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Randomized Controlled Trial Clinical Trial
[The use of lithium hydroxide for carbon dioxide absorption prevents formation of compound A during sevoflurane anesthesia].
Aim of the study was the clinical investigation of sevoflurane degradation when using water-free lithiumhydroxide versus moist Drägersorb 800 for carbon dioxide absorption. ⋯ When lithiumhydroxide is used, there is only minimal formation of compound A from sevoflurane degradation. Since serum fluoride levels increased in both patient groups, we conclude that this is caused mainly by metabolism of sevoflurane. Capacity of lithiumhydroxide for carbon dioxide absorption is similar to that of Drägersorb 800. Therefore, the use of lithiumhydroxide increases patient safety.
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Practice Guideline Guideline
[Advanced emergency life support measures in resuscitation. Guidelines of the European Resuscitation Council 1998].