Der Anaesthesist
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In patients with multiple injuries, the development of permeability edema can be assumed. However, no uniform shape of this fluid accumulation can be found even in the presence of severe injuries. Based on the first clinical observations, our aim was to search for correlations between the development of extravascular lung water (EVLW) and the individual injury pattern in severely traumatized ICU patients. ⋯ Increase of EVLW at a later time (day 7), as observed in groups B and C, is possibly the expression of a mediator and activator-induced "septiformal" injury of the microvascular endothelium. This may be caused by the underlying massive peripheral soft-tissue trauma. Specific elevations of EVLW subsequent to the individual injury pattern can indicate that that process has begun and is responsible for the origin of the microvascular injuries.
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We investigated the impact of norepinephrine administration on hemodynamics, oxygen metabolism and renal function in patients in severe septic shock. PATIENTS AND METHODS. Twenty-six patients with extremely low resistance who were between 24 and 87 years of age were included in the study. ⋯ When patients are in a septic high output-low resistance condition, particular attention must be paid to maintaining sufficient mean arterial pressures. Our results suggest that this essential goal can be achieved by norepinephrine. The mean arterial pressure and glomerular filtration rate improved markedly, and there was no evidence of bad effects such as an increased afterload on critical parameters like cardiac index, O2-delivery and O2-consumption.
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Small-volume resuscitation with hypertonic saline in combination with dextran appears to be very successful in experimental animals, where better results are achieved than in animals treated with a traditional infusion regime. This effect is apparently related to improved organ blood flow due to reflex vasodilatation. This reflex is based on the arrival of hypertonic solution in the pulmonary circulation. ⋯ CONCLUSION. We found that hypertonic NaCl (7.5%) with HH was well tolerated. Release of ANP and cGMP after HH infusion in healthy volunteers was not as high as expected, and the vasodilatory effect of hypertonic solutions was not explained by ANP or cGMP release in this investigation.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Tramadol in postoperative pain therapy. Patient-controlled analgesia versus continuous infusion].
Patient-controlled analgesia (PCA) is a well-proven procedure for individual pain relief in the post-operative period. Despite its superior approach regarding pharmacokinetic and pharmacodynamic considerations, PCA equipment is not available to many in the clinical practice. The goal of this study was to compare the efficacy and safety of PCA with continuous infusion (CI), an easily feasible method, using tramadol (T) as a centrally acting opioid with minor side effects on circulation and ventilation. ⋯ T is well suitable for postoperative pain relief after major gynecological surgery using both PCA and CI. PCA ensures adjustment of the medication to the individual demand, whereas CI provides better analgesia after sleeping periods. We recommend antiemetic prophylaxis before treatment with T.
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Anesthesiologists have always played a leading role in research into pain and its treatment. Their efforts, however, have been focused on acute or postoperative pain problems. It was the American anesthesiologist John J. ⋯ Organizational skills are also needed for efficient running of multidisciplinary pain treatment facilities. Clinical practice in surgical anesthesia means that anesthesiologists are experienced in interdisciplinary work and familiar with the advantages and dangers of team work. Despite international acceptance of the multidisciplinary approach to chronic pain, there is still a lack of appropriate facilities in the German-speaking countries, and we consider it important that anesthesiologists commit themselves to increasing general awareness of what is needed.