Der Anaesthesist
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Recruitment maneuvers have been proposed as an adjunct to mechanical ventilation to re-expand collapsed lung regions. Although, in most patients recruitment maneuvers improve gas exchange a controversial discussion on recruitment maneuvers remains. ⋯ The different recruitment maneuvers and possible monitoring are discussed as well as the influence of recruitment on other organs. Furthermore, we discuss whether recruitment maneuvers are useful if patients with acute lung injury or acute respiratory distress syndrome are ventilated with a lung-protective strategy.
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Diagnosis and therapy of hemodynamic instability are of the utmost importance in the treatment of critically ill patients during surgery and in intensive care. For both diagnosis and therapy, adequate and preferably continuous hemodynamic monitoring is essential. ⋯ The ongoing discussion on the risk-benefit ratio of such a pulmonary artery catheter has led to the introduction of several less invasive methods for determining cardiac output. The aim of this review is to provide background information on these alternative methods and to discuss the individual advantages and disadvantages of each method in the context of their clinical applicability.
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Clinical Trial
[Analgesia with remifentanil in spontaneously breathing patients undergoing brief but painful radiological procedures].
Percutaneous transhepatic biliary drainage (PTBD) and stenting are very painful procedures in interventional radiology and require potent analgesia; employing remifentanil in spontaneously breathing patients may be one possible strategy. ⋯ Employing a remifentanil infusion for brief interventional radiology procedures in palliative treatment of patients resulted in high patient and radiologist comfort.
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Case Reports
[Successful resuscitation of a patient with hyperkalemic cardiac arrest by emergency hemodiafiltration].
The combination of spironolactone with an ACE inhibitor for patients with heart failure may cause severe hyperkalemia. We report the case of a female patient, who developed hyperkalemic (11.4 mmol/l) cardiac arrest probably induced by combined spironolactone and ACE-inhibitor therapy. She was treated successfully by hemodiafiltration under on-going resuscitation which resulted in restoration of spontaneous circulation within 30 min of starting CPR. She was discharged 2 weeks later without any residual neurological effects.
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In the last 20 years molecular biology has expanded the horizons of medical research including anaesthesia. Preoperative identification of genetic disorders relevant to anaesthesia or increased perioperative risk will be available in the near future using molecular biology techniques. There has been a global increase of such publications, but the contributions from Germany, Switzerland and Austria are unknown. ⋯ The results of this study show the quantitative development of molecular biology research that has been done in anaesthesia institutions in Germany, Switzerland and Austria from 1988 to 2002. A continuous increase of publications with a molecular biology content occurred only in Germany.