Der Anaesthesist
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Case Reports
[Anesthesiologic aspects of pregnancy and delivery in a patient following a modified Fontan procedure ].
The number of patients with congenital cyanotic heart disease who reach child-bearing age is increasing. This is partly a consequence of the high long-term survival and the haemodynamic benefits resulting from the Fontan procedure, which is used for the definitive palliation of such cyanotic heart disease as tricuspid atresia and single ventricle. However, so far little experience has been recorded with pregnant patients who have undergone right ventricular exclusion procedures. ⋯ Impairment of venous return caused by slight caval compression or high airway pressure may reduce cardiac output more critically than in patients with a normal circulation. CONCLUSION. This case demonstrates that the haemodynamic consequences of pregnancy and of caesarean delivery under general anaesthesia can be tolerated in post-Fontan patients despite the absence of a contractile pulmonary ventricle.
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Clinical Trial
[Insertion of a fiber optic catheter into the hepatic veins of patients with multiple organ dsfunction syndrome (MODS)].
As it is the driving force in the development of a multiorgan dysfunction syndrome (MODS), the gastro-intestinal region is at the centre of current discussion. Recently, hepatovenous oximetry has been used increasingly to monitor the relationship between oxygen supply and consumption in the splanchnic system. In the present paper we report an exclusively oximetrically controlled catheterisation procedure that can be carried out at the bedside without the use of imaging procedures. ⋯ For this reason the opening of the hepatic veins could not be recognized by a decrease in saturation using the oximetric procedure. Placement of a catheter was not possible. Future studies on larger groups of patients will be required to show to what extent monitoring of ShvO2 can lead to an efficient therapy specific for this part of the cardiovascular system in patients with sepsis and MODS.
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Randomized Controlled Trial Clinical Trial
[Repeated addition of fentanyl to bupivacaine peridural analgesia in labor. Clinical action and fentanyl plasma level].
A combination of epidural opioids with local anaesthetics has been used to improve pain relief during labor and to reduce side effects, such as muscle weakness, usually seen when local anaesthetics are used alone. The addition of epidural fentanyl (F) produces highly effective analgesia, the only side effect being mild itching. Initial trials investigated the improvement in analgesia after a single administration of F during first- but not during second-stage labor. ⋯ In one newborn, radioimmunoassay resulted in unexplainably high umbilical F concentrations without any clinical signs of sedation, depressed vigilance and without any sequellae. DISCUSSION. Repeated addition of 100 micrograms F to epidural anaesthesia with bupivacaine significantly improves analgesia and provides pain relief not only during the fir
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Comparative Study Clinical Trial
[Evaluation of the oscillometric blood pressure monitors: Dinamap 1846 and HP M-1008B].
Using the PTB simulator, which emits real signals from patients, we examined the precision of the oscillometric blood pressure measurement with the Dinamap 1846 (Critikon) and the HP M-1008B (Hewlett Packard). For this purpose we simultaneously registered invasive arterial pulsewave, cuff pressure and cuff pressure oscillations of 20 patients from our intensive care unit and stored them in the database of the simulator. The invasive reference blood pressure values were determined following the recommendations given by the Association for the Advancement of Medical Instrumentation. ⋯ The American Association for the Advancement of Medical Instrumentation recommends a maximum mean error of 5 +/- 8 mmHg. None of the examined instruments lay within these limits. Due to the systematic and stochastic errors, we think that the Dinamap 1846 (Critikon) and the HP M-1008B (Hewlett Packard) do not achieve performance levels that are adequate for measuring critically ill patients.
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Case Reports
[Disturbance of continuous, pump administration of cardiovascular drugs by hydrostatic pressure].
Administration of highly concentrated, highly potent, and therefore highly dangerous drugs with syringe pumps is common in modern anaesthesia as well as in intensive care and emergency medicine. Because of their exact flow rates down to < 1 ml/h, these pumps are predestined for delivery of drugs with short half-lives, such as catecholamines and vasodilators. But intravenous application of drugs with syringe pumps is not without problems. ⋯ Even in a closed infusion system (syringe-extension-central venous catheter), hydrostatic pressure influences infusion rate. Elevation of the pump leads to unintended bolus administration, and lowering of the pump is followed by an interruption of the infusion. In the knowledge of this phenomenon, unexpected hemodynamic reactions during transport of critically ill patients cannot always be interpreted as a result of inadequate anesthesia or volume load, but may be a consequence of incorrect handling of the syringe pumps as described in this report.