Der Anaesthesist
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Pulmonary failure is almost always present in the early or late phase of multiple organ failure (MOF). Acute lung failure (ALF) is a uniquely constant response to direct or indirect insults to the lung. Increased pulmonary microvascular permeability (PMVP) is associated with the onset of lung permeability edema, the hallmark of ALF. ⋯ Direct injury seems to be the dominant mechanism for early manifestation (less than 72 h) of posttraumatic ALF. The thoracic trauma seems to damage the pulmonary endothelium directly, thus increasing PMVP in a circumscribed region. An overwhelming inflammatory response may cause the later increase in PMVP in the primarily healthy lung areas.
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Anesthesia may compromise the regulation of systemic and cerebral hemodynamics following changes in body position. Sudden decreases in cerebral perfusion pressure due to changes from a horizontal to a head-elevated position may cause decreases in cerebral blood flow (CBF), particularly in patients with preexisting cerebrovascular disease. Transcranial Doppler sonography (TCD) permits on-line measurement of blood flow velocity (BFV) in human basal cerebral arteries, and there is evidence that monitoring of BFV may indicate relative changes in CBF. ⋯ The MCA was insonated by transtemporal approach using a 2 MHz Doppler ultrasound system (TC2-64 B, EME) with a range-gating mechanism, adjustable sample volume depth, and flow direction discrimination. Systolic (Vsyst, cm/s) and mean flow velocity (Vmean, cm/s), pulsatility index (PI), mean arterial blood pressure (MAP, mmHg), heart rate (HR, b/min) and end-tidal CO2 (pet-CO2, mmHg) were recorded with the subjects lying flat (baseline values) and for 5 min following adjustment to a 35-40 degrees head-elevated position. There was a significant reduction of 25% for Vsyst from 79 +/- 17 cm/s (baseline) to 59 +/- 13 cm/s and a 33% decrease for Vmean from 52 +/- 9 cm/s (baseline) to 35 +/- 9 cm/s in group A immediately after repositioning.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Anesthesia induction in children: propofol in comparison with thiopental following premedication with midazolam].
Propofol provides smooth and rapid induction of anesthesia in adults and guarantees rapid recovery. The use of propofol in adults is frequently associated with pain on injection, but this can be reduced by: (1) injection into the relatively large veins in the forearm or the antecubital fossa: (2) addition of lignocaine to the propofol; or (3) injection of an opioid (alfentanil) before propofol. Compared with experience in adults, there is very little experience with propofol in pediatric anesthesia. ⋯ Apnea for 20 s was observed only in groups B and C (2 and 3 children respectively). During spontaneous respiration with room air there was a significant decrease of the arterial oxygen saturation about 1 min after induction in all groups. In children ventilated with oxygen by mask, the SaO2 remained nearly constant...
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Extraoral tape fixation of the orotracheal tube for general anesthesia is a major problem in maxillofacial surgery. First of all, surgical access to the perioral and nasal region is handicapped by the tape covering and distracting the skin, especially in those cases where no nasotracheal intubation is possible; furthermore, blood, saliva, and disinfectant fluid interfere with reliable adhesion of the tape. A method of intraoral dental fixation of the orotracheal tube by a rubber dam fixation clamp is presented. The rubber dam isolates teeth against the oral cavity, providing a dry operative field to the dentist. The set of clamps, each designed according to the individual anatomy of the different teeth, is usual in the dental trade. After intubation the selected clamp is placed on the tooth by means of the forceps. The tube is laid on the clamp and tied on by a silk thread (2 x 0), which is inserted through the clamp's holes. We recommend fixation to the teeth in the mandible to avoid tension load, which could strain teeth in the maxilla; as far as possible only teeth without any impairment (e.g. loosening) should be selected. ⋯ The method of intraoral dental fixation of the orotracheal tube by a rubber dam clamp offers the following advantages: (1) the surgeon, especially the maxillofacial surgeon, has a good view of the perioral region and free access for surgery; there is (2) no skin distraction or irritation by tape; there is (3) reliable tube fixation even for patients with allergy to adhesive materials; there is (4) no solution of tape fixation by blood, saliva, or disinfectant fluid; and (5) silk sutures cannot be subjected to strain when solving tape fixation.
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Randomized Controlled Trial Clinical Trial
[Hyperosmolar volume replacement in heart surgery].
The ideal solution for use in volume therapy is still a matter of debate. Hypertonic sodium (HS) solutions have been advocated for resuscitation from hemorrhagic shock (small volume resuscitation). As hypertonic fluids may also be of interest in cardiac surgery, the effects of a new HS solution were studied. ⋯ The hypertonic saline HES solution adds a new dimension to volume therapy for cardiac surgery patients. The improvement in hemodynamics was effective and not only transient. Fluid requirements were significantly reduced during as well as after CPB, and pulmonary gas exchange was least compromised in these patients.