Der Anaesthesist
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Priming can significantly shorten the onset of nondepolarizing neuromuscular blocking agents (NNBA) measured at the adductor pollicis muscle (APM). In spite of the known risks, priming is very popular especially in cases where NNBAs with a long onset time are used. However, there are no data regarding the onset of action for a priming technique measured at the laryngeal muscles although these muscles are of great importance for conditions of intubation and patient safety. The aim of this study was to compare a bolus application and a priming technique with respect to the laryngeal onset time and peak effect. ⋯ Our results show that only high dose priming of cisatracurium can significantly shorten the laryngeal onset time. However, clinical routine use is not recommended due to possible side-effects.
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Case Reports
[Vasopressin as a rescue vasopressor agent. Treatment of selected cardiogenic shock states].
Vasodilatory shock is the most common form of shock in the critically ill patient. As a consequence of overwhelming and prolonged mediator production, vasodilatory shock can be the common final pathway of primary non-vasodilatory shock (e.g. cardiogenic or hypovolemic shock). ⋯ The hemodynamic effects of AVP were comparable to those AVP-induced alterations described in septic shock and seem to be predominantly mediated by potent vasoconstriction and the facilitated reduction of higher, potentially toxic catecholamine doses. Thus, an AVP-induced decrease in heart rate and pulmonary arterial pressures may be particularly beneficial in patients with impaired cardiac function.
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Angioneurotic orolingual edema associated with the use of rt-PA (recombinant tissue plasminogen activator) for systemic thrombolysis are described in the literature, but only as isolated case reports. Strangely, the rate of anaphylactic reactions to rt-PA is higher (1.9%) when they are used in the treatment of acute stroke than when they are given to treat acute myocardial infarction (0.02%). Patients who are taking ACE inhibitors seem to be at increased risk of such a potentially life-threatening event. ⋯ Both these patients were taking ACE inhibitors. It was possible to avoid intubation and ventilation in both cases. Therapy with ranitidine, clemastine, and a C1 esterase inhibitor resulted in the resolution of symptomatic angioneurotic edema within hours.
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Knowledge about the incidence of errors in anaesthesia and intensive care is only rudimentary but it appears justified to assume that errors occur much more often than we all expect. One reason is most likely the complexity of our work. ⋯ The article summarizes several methods to identify errors within a health care system and strengthens the importance of error analysis to reduce its incidence. Results of an analysis should be published if they are of general interest.
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For a long time the significance of perioperative accidental hypothermia was overlooked. The possible undesirable effects of a relatively small reduction in the body core temperature of 1.5-2.0 degrees C were generally unknown and the treatment options were limited. The unfavourable climatic conditions in the operation room favour heat loss and simultaneously, there is considerable disturbance of temperature regulation through general as well as spinal anaesthesia. ⋯ In addition, the undesirable effects of such a reduction in core temperature were barely known and even only a few years ago there were hardly any possibilities for reliable prevention or effective treatment. Therefore, in this article the causes of perioperative hypothermia will initially be described. In the second section the possible negative consequences of a reduction in body core temperature will be presented and in the last section the resulting consequences for the practice will be discussed.