Der Anaesthesist
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Catecholamines are currently the most often used vasopressor agents in the treatment of vasodilatory shock. However, progressive catecholamine resistance is a feared complication. Recent studies have shown that arginine vasopressin, an endogenous hormone of the neurohypophysis, may be a potent vasopressor when used in combination with catecholamines. ⋯ In the guidelines of both the "American Heart Association" and the "International Liaison Committee on Resuscitation" from the year 2000, arginine vasopressin is recommended as a possibly helpful agent in therapy refractory vasodilatory septic shock. There is currently limited data on possible side effects of a continuous arginine vasopressin therapy in vasodilatory shock. Therefore, arginine vasopressin should be restricted to patients where adequate stabilization of hemodynamic function cannot be achieved by conventional vasopressor therapy alone.
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The orthogonal polarization spectral (OPS) imaging technology is a new non-invasive method to directly visualize multiple conditions of the microcirculation which has several clinical applications in humans. Quantitative measurement of the diameter of vessels, the velocity of red blood cells and functional capillary density (FCD) can be made. ⋯ A transdermal approach can be used in premature babies and neonates to view the microcirculation and has also been used experimentally to determine haemoglobin levels. The application to various surfaces and solid organs allows a variety of pathophysiologies and phases to be examined.
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Between 40 and 90 cardiopulmonary resuscitations are performed per 100,000 inhabitants each year in western industrialised nations. In 50-70% of these patients, either fulminant pulmonary embolism or acute myocardial infarction is the underlying cause of cardiac arrest. Based on this fact, thrombolysis may represent a new and effective causal therapeutic strategy in patients suffering from cardiac arrest due to acute myocardial infarction or fulminant pulmonary embolism. ⋯ This coagulation imbalance is thought to be responsible for postresuscitation cerebral microcirculatory reperfusion disorders in patients after cardiac arrest and cardiopulmonary resuscitation. In summary, recent clinical and experimental data focusing on thrombolysis during cardiopulmonary resuscitation strongly indicate, that thrombolysis may represent a new and relatively safe therapeutic option during resuscitation after cardiac arrest due to acute myocardial infarction or fulminant pulmonary embolism. If the results of an international randomised, controlled clinical multicentre trial presently underway confirm the previous clinical findings, thrombolysis during cardiopulmonary resuscitation could become an important part of future cardiopulmonary resuscitation algorithms.
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The action profile of succinylcholine is unmatched even 50 years after its introduction into anaesthestic practice. This is probably why succinylcholine, despite its many and partly life-threatening side-effects, is still considered to be indispensable by many anaesthetists and emergency doctors. The main indication for succinylcholine--the facilitation of endotracheal intubation in patients considered to be at an increased risk of aspiration of gastric fluid, e.g. patients undergoing a Caesarean section or presenting with an ileus--remains undisputed. ⋯ In the case of an expected difficult airway no muscle relaxant should be given, because severe hypoxaemia in these patients probably can only be prevented by a professional airway management. Succinylcholine is no longer an option in elective paediatric anaesthesia. The drug, however, retains its value in critical situations where a rapid onset but a short duration of action is of prime importance.