Der Anaesthesist
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In 1977 a new anaesthesiology preoperative evaluation clinic was started for evaluation of all elective surgical patients for their fitness to undergo anaesthesia. Physical examination, medical history and anaesthetic risk assessment are assessed in a standardized manner with the aid of computer menus. Comprehensive laboratory tests included electrocardiography, lung function assessment (vital capacity and forced exspiratory volume within 1 s), chest X-ray, and arterial blood gas analysis and blood chemistry analysis with an SMA-22 (System Multi Analyzer). ⋯ We found that perioperative complications and adverse outcome correlated with preoperative data and physical examination. The main source of perioperative morbidity and mortality was the cardiovascular system, followed by nephrologic diseases, correlating exactly with preoperative BUN and plasma creatinine. These studies also underlined the value of the ASA physical status to predict perioperative outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
[The effect of thoracic epidural anesthesia on the pathophysiology of the eventration syndrome].
Abdominal mesenteric traction (MT) results in decreased mean arterial pressure (MAP), systemic vascular resistance (SVR) and increased cardiac output (CO). This response is induced by a considerable release of prostacyclin (PGI2). Precipitous falls in systemic arterial pressure related to central and/or autonomic nervous reflex arcs also have been described during operations on the upper abdominal viscera. ⋯ Our data clearly indicate that the mesenteric traction response consists in relevant haemodynamic alterations and a significant decrease of paO2. Stable haemodynamics and paO2 following cyclooxygenase inhibition signify an action mediated by prostacyclin. Deafferentation of the splanchnic nerves by supplementary thoracic epidural anaesthesia did not influence either prostacyclin release or the decrease in blood pressure and paO2 after traction on the mesentery root...
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The interaction of immunocompetent cells with the vascular endothelium is of prime importance for the development of septic multiple organ failure. There is evidence from in-vitro studies that the methylxanthine derivative pentoxifylline can attenuate the extent of inflammatory reactions by amplification of cell-derived endogenous regulators. ⋯ Consequently, pentoxifylline improves perfusion in the microcirculation as well as tissue oxygenation. Further studies will clarify whether the promising results obtained with pentoxifylline in experimental septic shock will be confirmed under clinical conditions.
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Various new muscle relaxants are available: atracurium, rocuronium and vecuronium all have an intermediate duration of action, whereas doxacurium and pipecuronium are long-acting and mivacurium is a short-acting nondepolarizing muscle relaxant. The duration of action of atracurium and mivacurium is determined by their degradation, which makes them unique among the nondepolarizing muscle relaxants in this respect. ⋯ Because recovery from them is slow, long-acting agents should preferentially be used only when postoperative mechanical ventilation is intended. The use of a peripheral nerve stimulator is the only reliable guide to appropriate administration of muscle relaxants.
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Stenotic processes of the tracheobronchial system may lead to dyspnoea that can become lift-threatening. To restore sufficient function of the blocked airway, a silicone stent can be inserted. The anaesthesia techniques used for this intervention so far have been complicated. The object of this study was to determine whether the super-imposed high-frequency jet ventilation (SHFJV) via the jet laryngoscope originally designed for microlaryngeal surgery can be utilized for endoluminal stent insertion. ⋯ First clinical applications of the jet laryngoscope combined with superimposed jet ventilation for stent insertion demonstrated satisfactory results. Not only were the patients ventilated throughout the procedure, but CO2 elimination was also satisfactory. Superimposed jet ventilation provides a sufficient tidal volume with low ventilation pressures, and therefore oxygenation and CO2 elimination are unproblematic. SHFJV enables the anaesthetist to ventilate the patient nearly continuously with minimal phases of apnoea. The only apnoea phases, as with any other method, occur during surgical manipulation while inserting the stent and thus blocking the airway. We believe that the jet laryngoscope with SHFJV presents a distinct advantage for both anaesthetist and surgeon when inserting stents in the tracheobronchial system.