Der Anaesthesist
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Pain is a major, but largely neglected problem in AIDS patients. The aim of this article is to review the etiology of pain manifestations in AIDS patients in different organ systems and to discuss appropriate treatment strategies. The most common pain symptoms in AIDS patients are headache, oral cavity pain, dysphagia and adynophagia, chest pain, abdominal pain and pain related to peripheral neuropathy. ⋯ In view of the multiple organs involved in the presentation of AIDS requiring multiple drugs, careful attention to side effects, contraindications and drug interactions is warranted, when administering pain medications. Fear of the complexity of these issues should, however, not prevent effective pain management for these patients, who suffer from a fatal disease. A multidisciplinary approach to pain in AIDS patients, similar to the approach in patients with cancer, is desirable.
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Comparative Study Clinical Trial
[Cardiac output determination with transpulmonary thermodilution. An alternative to pulmonary catheterization?].
Cardiac output measurements are often helpful in the management of critically ill patients and high risk-patients. In this study an alternative technique for measurement of cardiac output by the transpulmonary indicator dilution technique (TPID) was evaluated in comparison to conventional thermodilution using a pulmonary artery catheter. With TPID, a thermistor-tipped catheter (the smallest available is 1.3 F) is placed in the aorta via a femoral artery introducer. Thus, TPID can also be used in very small children in whom placement of a pulmonary artery catheter may be difficult or even impossible. In principle, TPID is less invasive since the possible complications of the pulmonary catheters are avoided. We investigated the accuracy and reproducibility of transpulmonary thermodilution in patients over a broad range in age and body surface. ⋯ The amplitude of the typical arterial thermodilution curve shows a smaller and more delayed course than the pulmonary artery thermodilution curve. There was a very good correlation between the values found by pulmonary and TPID cardiac output measurements (R = 0.968). There was a slightly smaller cardiac output value measured by the TPID (Bias = -4.7 +/- 1.5% sem) The reproducibility of duplicate measurements with the two methods were nearly the same, the standard deviation of the difference was 10.9% for the pulmonary thermodilution method and 11.7% for TPID. DISCUSSION. TPID gives an alternative technique for measurement of cardiac output. We showed over a broad range in age and body surface a very good correlation with thermodilution measurements in the pulmonary artery. The slightly smaller values for TPID are explained by early recirculation, for clinical purposes the difference is negligible. However, the reproducibility of a method is clinically very important. Both methods showed in duplicate measurements basically the same reproducibility. The disadvantage of TPID in being more sensitive to baseline alteration is counterbalanced by less respiratory variability in comparison to the conventional thermodilution technique. However, by increasing the amount of injected indicator (i.e., 0.2 ml/kg approximately equal to 15 ml in an adult) it is possible to reduce the effect of baseline alteration. By using fiberoptic catheters it is even possible to use TPID as double-indicator dilution technique to measure intrathoracic blood volume (ITBV) and extravascular lung water (EVLW). We conclude that in many patients TPID might be an attractive, less invasive and reliable alternative to conventional cardiac output measurement by pulmonary artery catheter.
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Heat loses during surgery occur mainly to the environment and due to infusions and irrigations. Infusions given at room temperature account for a great deal of the total heat deficit during major operations, e.g., the infusion of 53 ml/kg 20 degrees C fluid leads to a loss of 1 degree C in mean body temperature. Hence, heating i.v. fluids will add to the effect of other measures aimed at reducing heat loss to the environment. We investigated the efficacy of different warming methods for i.v. fluids in an experimental model by measuring the temperature at the end of the delivery line. ⋯ The importance of infusion warming increases with the amount of fluid given.(ABSTRACT TRUNCATED)
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Comparative Study Clinical Trial
[Infrared temperature measurement in the ear canal with the DIATEK 9000 Instatemp and the DIATEK 9000 Thermoguide. Comparison with methods of temperature measurement in other body parts].
Temperature of the tympanic membrane is recommended as a "gold standard" of core-temperature recording. However, use of temperature probes in the auditory canal may lead to damage of tympanic membrane. Temperature measurement in the auditory canal with infrared thermometry does not pose this risk. Furthermore it is easy to perform and not very time-consuming. For this reason infrared thermometry of the auditory canal is becoming increasingly popular in clinical practice. We evaluated two infrared thermometers-the Diatek 9000 Thermoguide and the Diatek 9000 Instatemp-regarding factors influencing agreement with conventional tympanic temperature measurement and other core-temperature recording sites. In addition, we systematically evaluated user dependent factors that influence the agreement with the tympanic temperature. ⋯ Although easy to use, infrared thermometry requires careful handling. To obtain optimal recordings, the time between two consecutive readings should not be less than two min. Recordings should be taken immediately after positioning the devices in the auditory canal. Best results are obtained in the 60 degrees position with the grip of the devices following the ramus mandibulae (telephone handle position). The lower readings of infrared thermometry compared with tympanic contact probes indicate that the readings obtained represent the temperature of the auditory canal rather than of the tympanic membrane itself. To compensate for underestimation of core temperature by infrared thermometry, the results obtained are corrected and transferred into core-equivalent temperatures. This data correction reduces mean differences between infrared recordings and traditional core-temperature monitoring, but leaves limits of agreement between the two methods uninfluenced.
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Comparative Study Clinical Trial
[Measurement of human cerebrovascular circulation. Comparison of Kety-Schmidt technique with the intravenous 133-xenon clearance technique].
In this study cerebral blood flow (CBF) was simultaneously measured with the Kety-Schmidt method and the intravenous 133Xe clearance technique. CBF, cerebral metabolic rate of oxygen (CMRO2), and CO2 reactivity of CBF were compared under fentanyl-midazolam anaesthesia and varying paCO2 levels. ⋯ Most probably due to contamination with radioactivity from slowly perfused extracerebral tissues the intravenous 133Xe-clearance technique underestimates CBF, CMRO2, and cerebrovascular CO2 reactivity, at least when CBF15 values are used as flow parameters.