Der Anaesthesist
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Gallstone lithotripsy is a new and noninvasive therapeutic option for approximately 20% of patients who harbor cholesterol gallstones. Technologically advanced second-generation lithotripters such as the Dornier MPL 9000 device have greatly simplified biliary lithotripsy with a consecutive reduction in anesthetic requirements. Despite these technical improvements, patients still can experience considerable pain and discomfort during biliary ESWL. ⋯ If not, more alfentanil was allowed to accumulate until continuous treatment was tolerated. Further in- or decreases of the infusion rate were titrated according to patient response. Registered variables included the required alfentanil loading dose, maintenance and total doses, and the applied shock wave energy approximated by multiplication of shock wave number and voltage squared.(ABSTRACT TRUNCATED AT 250 WORDS)
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Extracorporeal CO2 elimination (ECCO2-R) is a new approach to the treatment of severe respiratory failure. Gas exchange is separated into oxygen uptake by apneic oxygenation through the natural lungs while CO2 is removed extracorporeally with an artificial organ. The physiological conditions of both processes can thus be optimized. ⋯ This is dependent upon gill reduction and skin armor to prevent evaporation leading to a rise in pCO2 from 3-4 to 40 mmHg and a tenfold increase of serum bicarbonate levels. We believe that the developmental history of respiration justifies the use of a bimodal gas exchange system. It is clinically applied as extracorporeal CO2 removal with membrane lungs (ECCO2-R) or, still under investigation, in a hemodialysis-related procedure (extracorporeal bicarbonate/CO2 removal: ECBicCO2).
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Randomized Controlled Trial Comparative Study Clinical Trial
[Lung inflation or mechanical ventilation in extracorporeal circulation?].
Extracorporeal circulation (ECC), with its shock-like pulmonary perfusion, leads to pathomorphologic and functional pulmonary changes, the postperfusion syndrome. This study investigated the effects of different types of ventilation during ECC on postoperative pulmonary function and the resulting pulmonary blood gas changes. METHOD. ⋯ Pulmonary ventilation during ECC can prevent a post-operative increase in venous admixture. ECC-related pulmonary vascular changes were not affected by ventilation. Middle-frequency ventilation offers no advantage over low-frequency ventilation during ECC, except that the operating field is more quiet.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of sufentanil in high doses on hemodynamics and electroencephalography activity in coronary patients].
Sufentanil, a synthetic opioid that is 5-10 times as potent as fentanyl, has been suggested by some authors to prevent hypertensive responses to noxious stimuli in patients undergoing coronary artery bypass surgery much better than fentanyl, while in other studies it has failed to maintain cardiovascular stability during surgical stimulation. This study was designed to investigate the cardiovascular and electroencephalographic effects of high-dose sufentanil/O2/pancuronium anesthesia in patients undergoing coronary artery bypass surgery. METHODS. ⋯ Cardiac and stroke volume indexes stayed significantly lower than the awake values, whereas heart rate remained essentially unchanged during the course of the study. There were no statistically significant differences between the groups during all measurements. In the EEG, sufentanil anesthesia was characterized by a decrease in the number of higher frequency waves and an increase in lower frequency (delta) waves, which did not change during sternotomy in 17 of the 20 patients.
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Transfusion of homologous blood components is associated with immunological (incompatibility, alloimmunization, immunosuppression) and infectious risks (hepatitis, cytomegalovirus, HIV and other agents). Endoprosthetic surgery of the hip and knee frequently requires transfusion. Preoperative deposit of autologous blood can reduce homologous transfusion requirements. ⋯ Forty-six patients (23 men, 23 women) underwent total hip arthroplasty, 12 (4 men, 8 women) exchange of total hip arthroplasty, and 5 (3 men, 2 women) endoprosthetic knee surgery. In total hip arthroplasty men required 0 to 500 ml homologous packed red cells (median=0), women 0 to 1250 ml (median=0;p less than or equal to 0.05). Thirty-nine (69.6%) of the patients, 19 (82.6%) men and 13 (56.5%) women, did not require homologous transfusion.(ABSTRACT TRUNCATED AT 400 WORDS)