Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Hemodynamics and myocardial energy balance in coronary surgery patients during high-dose fentanyl-pancuronium anesthesia and modified neurolept-pancuronium anesthesia].
In 8 patients with coronary artery disease (CAD) classed as NYHA II or III, anesthesia was induced with high-dose fentanyl (0.05 mg/kg) and pancuronium (0.1 mg/kg). The patients were ventilated normally with the aid of a mask (O2: air 1:1, tidal volume 10 ml/kg with a rate of 10/min) for 5 min and then intubated. In 8 further patients with CAD NYHA class II or III, anesthesia was induced with 0.02 mg/kg flunitrazepam, N2O/O2 1:1 and isoflurane 0.5 vol%; they were relaxed with pancuronium (0.1 mg/kg) in combination with a bolus of 0.005 mg/kg fentanyl. ⋯ Measurements and an electrocardiogram were taken before anesthesia, after induction of anesthesia and after intubation. The hemodynamic parameters HR, AP, CI, CPP were relatively stable in patients anesthetized with high-dose fentanyl and pancuronium, whereas we found greater decreases in these parameters with the balanced anesthesia technique. Determinants of myocardial oxygen demand were higher in the high-dose fentanyl group; therefore, myocardial blood flow and oxygen consumption did not decrease to the same extent as in the balanced anesthesia group.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.
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Fiberoptic endotracheal intubation with an endoscope (external diameter 4 mm) especially designed for anesthesiologists proved to be safe providing small-diameter tubes were used. The use of large-diameter tubes (I. ⋯ When this new tube was used there were no problems either in passing the bronchoscope through this "inner" tube or in withdrawing the inner tube after successful intubation. With the new device it was even possible to pass tubes with wider lumen into the trachea over the fiberscope with minimal difficulty and trauma.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Coagulation changes during aortofemoral bifurcation bypass: is volume and plasma substitution possible with hydroxyethyl starch alone?].
The study explored the possibility of eliminating the need for plasma replacement with expensive human albumin (HA) and fresh frozen plasma (FFP) and instead using hydroxyethyl starch (HES). Patients undergoing infrarenal aortofemoral bifurcation grafting were randomly assigned to one group, which received FFP and HA, or another group, which received HES as volume replacement. Blood specimens were collected at five time intervals: preoperatively, prior to cross-clamping of the aorta, prior to declamping, at the end of the operation, and 6 h postoperatively. ⋯ Plasminogen, fibrinogen, antithrombin III, and antiplasmin concentrations fell significantly in both groups; 10% to 20% lower values were determined within the HES group due to the lack of factor substitution. The reduction in the coagulation factors can be explained as a dilution effect, but there are also signs of a consumption reaction taking place at the onset of the operation involving activation of coagulation and fibrinolysis. Restricting the use of FFP and simultaneously increasing HES administration is justifiable in procedures involving the abdominal aorta with moderate blood loss.
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Comparative Study
[The effect of fresh gas flow on the minute volume of anesthesia ventilators with a gas reservoir].
The tidal volume (TV) delivered by conventional anesthesia ventilators is dependent on fresh gas flow rate (FGF). When FGF is reduced, the TV declines; this must be corrected by increasing the ventilator bellows excursion. In addition, the falling bellows produce a negative pressure during the expiratory phase, which may result in positive negative pressure ventilation (PNPV). ⋯ VI-VOLEC (with the relief valve closed) and AV 1 had a loss of less than 10% of the initial TV. Adding a reservoir bag to anesthesia ventilators is an effective method of guaranteeing a TV independent of FGF. The three ventilators tested here proved suitable for minimal-flow anesthesia.