Der Anaesthesist
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Clinical Trial
[Laryngeal surgery with a 3-D technique. Early results with the jet-laryngoscope in superimposed high-frequency jet ventilation].
Surgery by three-dimensional (3D) endoscopy is being used routinely in abdominal surgery and, in special cases, in thoracic surgery; however, it has not been reported as being used in microlaryngeal surgery. METHODS. We inserted a 3-D endoscope into a jet laryngoscope and studied the pressure properties at the tip of the laryngoscope as well as intrapulmonary pressures while applying superimposed high-frequency jet ventilation. ⋯ In the clinical application of 3-D endoscopy via a jet laryngoscope, it was possible to achieve sufficient ventilation, inspection of the surgical field, and performance of the surgical procedure. A CO2 laser was used without changing the ventilation regime. Although technical alterations would be desirable for its application to microlaryngeal surgery, it is presently possible to safely use the 3-D endoscope via the jet laryngoscope for microlaryngeal surgery, presenting the surgeon with new possibilities in voice-improving microsurgery of the larynx.
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We report two cases of compartment syndrome of the lower leg that occurred in male patients aged 62 and 57 years, respectively, after 10 and 12-h urological surgery in the lithotomy position. During sedation and mechanical ventilation creatine kinase (CK) activity of more than 8,000 U/l was found in both patients. After extubation, clinical symptoms of the compartment syndrome were found. ⋯ The deep veins of the legs should be checked by phlebography. In cases of verified compartment syndrome, early fasciotomy is the best choice of therapy, because neuromuscular defects are known to be irreversible after 12 to 24 h. Enforced diuresis is recommended in order to avoid renal complications.
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In order to assess the significance of drug levels measured in clinical and forensic toxicology as well as for therapeutic drug monitoring (TDM), it is essential that good collections of data are readily available. For more than 400 frequently used drugs therapeutic and, if data were available, toxic and fatal plasma concentrations as well as elimination half-lives were compiled in a table including, e.g., hypnotics like barbiturates and benzodiazepines, neuroleptics, antidepressants, sedatives, analgesics, anti-inflammatory agents, antihistamines, anti-epileptics, beta-adrenergic antagonists, antibiotics (penicillins, cephalosporins, aminoglycosides, gyrase inhibitors), diuretics, calcium-channel blockers, cardiac glycosides, anti-arrhythmics, anti-asthmatics, angiotensin converting enzyme inhibitors, opioid agonists, and local anaesthetics. ⋯ The range of (or single) half-life values given for each drug are chosen to represent the terminal log-linear phase at most. In addition to the assessment of significance of drug levels for the therapeutic monitoring of patients, this list can assist the diagnostic assessment in cases of intoxication.
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Acute upper gastrointestinal bleeding in ICU patients has many possible causes: ulcer, adverse drug effects, gastric tube lesion, acute renal or liver failure, or stress-induced gastric mucosal lesion. Stress-induced gastric mucosal lesions typically are multiple superficial erosions, while ulcerations typically occur in patients with head trauma, neurosurgical operation or severe burns. Head trauma and neurosurgical patients are the only ones with increases gastric acid secretion; in general reduced acid secretion can be observed in ICU patients. ⋯ Active acid secretion depends on sufficient oxygen supply and mucosal ATP content. Hypotension and shock results in gastric mucosal ischaemia. These are the most important risk factors of stress bleeding.
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Comparative Study Clinical Trial
[Plethysmechanomyography (PMG). A simple method for monitoring muscle relaxation].
Ideal evaluation of neuromuscular blockade can be done by mechanical or electromyographical registration of muscle contractions evoked by ulnar nerve stimulation. Unfortunately, devices needed for such registration are expensive or complicated to set up, and thus are not often used for routine monitoring in anaesthesia. In this study, we describe a simple and low-priced method permitting intra- and postoperative monitoring of neuromuscular blocking agents. ⋯ Mechanomyography and EMG are well established methods of neuromuscular monitoring. Our data demonstrate that PMG provides a reliable measurement of neuromuscular transmission that correlates well with EMG. Since only materials of daily use in anaesthesia are needed, no substantial costs will arise when the plethysmographic method of measurement is used for routine anesthetic monitoring.