Der Anaesthesist
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The second part of this overview focuses on how to assess more complex metabolic causes of acid-base imbalance. This is precisely the battlefield where most of the fiery debates between the Copenhagen, the Boston and the Stewart schools aroused. ⋯ With the Stewart diagnostic approach in mind the practitioner might wish considering therapeutic options that differ from what is suggested by the more traditional approaches. The specific diagnostic steps are integrated into a simplified algorithm and an acid-base calculator is provided.
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Comparative Study
[Comparison of antifog methods in endoscopy. What really helps].
The use of a flexible or rigid fiberoptic bronchoscope belongs to the standard repertoire in anesthesiology. Besides a lack of training these procedures may be considerably compromised by endoscopic lens fogging. Several antifogging approaches are commercially available but to date no controlled studies regarding the efficacy of these devices in bronchoscopes exists. The aim of the present study was to compare the efficacy of different commercially available anti-fogging techniques for rigid and flexible bronchoscopes. ⋯ All commercially available antifog liquids and wipes showed slightly different reduction of lens fogging. However, other factors such as frequency of usage, the type of endoscope, hygiene properties as well as cost-effectiveness might have a substantial impact on the comparison of all tested anti-fog devices. The use of an endoscope preheater system might be a conceivable alternative method to reduce lens fogging despite the higher initial cost. However, the multiple use of the preheater system cannot be recommended at present as additional handling procedures to ensure an appropriate but safe temperature of the endoscopic tip should be provided by the manufacturer. Application of a continuous oxygen flow was shown not to be effective in preventing lens fogging using a flexible fiberoptic bronchoscope.
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The case of a female patient with a suprasellar optic glioma is reported, who was admitted to the intensive care unit due to decompensated diabetes insipidus with hypernatremia of 194 mmol/l. The sodium concentration was reduced slowly over 4 days and the patient recovered without sequelae. ⋯ An increase in extracellular osmolarity leads to augmented production of intracellular osmolytes in order to maintain the cell volume constant. Due to this counterregulation correction of the sodium concentration must be done with caution.
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Case Reports
[Functional separation of the lungs. Ventilation strategy for unilateral blunt force thoracic trauma].
Independent lung ventilation was performed in a patient with severe hypoxemia (oxygenation ratio p(a)O₂/F(I)O₂ 61 mmHg) due to unilateral blunt chest trauma and consecutive consolidation of the injured lung. Recruitment and immobilization of the consolidated lung was achieved by functional separation of both lungs with application of a mean airway pressure (p(mean)) of 28 mbar in combination with low frequency ventilation (4/min) of the injured lung. Adequate ventilation was maintained via the normal lung (p(mean) 14 mbar). This ventilation strategy stabilized oxygenation and ventilation by preventing overinflation and ventilator-induced lung injury.
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This case report of a silent cardiotocogram (CTG) registration during general anesthesia in a 33-week-pregnant patient undergoing non-obstetric surgery demonstrates the possibility of misinterpretation whereby typical CTG patterns of fetal reactions to anesthetics can be misinterpreted as fetal hypoxia or even asphyxia.