Der Anaesthesist
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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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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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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 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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Cardiopulmonary resuscitation (CPR) during pregnancy is a rare event, but due to the increasing number of pregnant women with significant medical disorders it will gain more importance in the near future. Effective CPR with respect to survival of mother and infant can only be accomplished under optimal conditions. We discuss important pathophysiological alterations during pregnancy and, including recommendations in the available literature, we present a standardized protocol for life support for mother and infant. ⋯ Compared to non-pregnant patients, pregnant women must be placed in a left lateral position immediately. If possible, the decision to perform open-chest CPR has to be made within 15 min of unsuccessful closed-chest CPR. In addition, during late pregnancy there should be no delay in performing an emergency cesarean section, even during CPR.