Der Anaesthesist
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While in animal experiments neurogenically initiated pulmonary edema is a well known event and is supposed to be due to centrally initiated hemodynamic disturbances ("neurohemodynamics") in patients with severe cerebral lesions fulminant alveolar edema is reported to occur very rarely. The questions addressed by this study are: 1. whether and to what extent changes in extravascular lung water (EVTVL) can be demonstrated in patients with a severe isolated cerebral lesion; 2. whether a relationship between the severity of the cerebral lesion and accompanying EVTVL changes can be proven; and 3. whether or not EVTVL changes are associated with corresponding changes in intravascular hydrostatic and oncotic Starling parameters; i.e. cardiogenic or noncardiogenic pulmonary edema accompanying the cerebral lesion. This study included 44 patients presenting with a severe isolated cerebral lesion and decerebrate posturing on admission. ⋯ While survivors (n = 13) remained within the normal range of EVTVL (less than 9 ml/kg), non-survivors (n = 31) started at an already elevated level (10.05 +/- 1.04 ml/kg) and reached their maximum values (15.4 +/- 2.3 ml/kg) on day 3 to 4. In 3 non-survivors these increased initial EVTVL values were accompanied by pathologically increased intravascular pressures, indicating that hydrostatic mechanisms were involved in the EVTVL rises. While the hydrostatic pressures normalized spontaneously, EVTVL values stayed within the pathological range throughout the remaining observation period.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[A comparison of the course of anesthesia using a bolus application of propofol, methohexital or etomidate as hypnotics and alfentanil analgesia].
The suitability of the analgesic-hypnotic combination alfentanil-propofol in nitrous oxide-oxygen IPPB for short-term and outpatient anesthesia was studied in 50 patients of ASA risk groups I and II. This study appeared pertinent since the two substances have the shortest half-lives of their respective classes of medication. For comparison, two groups of similar size were treated with the well-established combinations alfentanil-methohexital and alfentanil-etomidate. ⋯ These patients also showed the most rapid recovery; consequently, the combination of alfentanil and propofol would appear to be especially suitable for outpatients. For the induction of anesthesia alfentanil was administered in a dosage of 30 micrograms/kg body weight in combination with propofol 1.5 mg/kg, methohexital 1.0 mg/kg or etomidate 0.2 mg/kg. For anesthesia maintenance the following mean dosages were found to be suitable: Alfentanil 1 microgram/kg/min, propofol 46 micrograms/kg/min, methohexital 24 micrograms/kg/min, and etomidate 4 micrograms/kg/min.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Fentanyl versus sufentanil basic anesthesia. Hypnotic effect, muscle rigidity and efficacy of competitive muscle relaxants].
As induction agents for cardioanesthesia, sufentanil (S) and fentanyl (F) are usually employed in combination with nondepolarizing muscle relaxants. We investigated potential interactions of these opioids with the relaxant component, paying special regard to the role of muscular rigidity and opioid-induced alterations of hemodynamics. Narcotic anesthesia was induced randomly in 45 coronary artery bypass patients with either F (20 micrograms/kg) or S (4 micrograms/kg). ⋯ Muscular rigidity was moderate in 25% of patients and severe in 35%-40%, during the administration of both narcotics. No significant differences between S and F were observed. During ventilation by face mask, patients with clinically apparent rigidity showed a statistically significant mean increase in paCO2.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
[Fulminant sepsis following posttraumatic splenectomy--OPSI (overwhelming postsplenectomy infection) syndrome].
We report a case of fulminant sepsis 10 years after posttraumatic splenectomy. The low-cardiac-output stage of the septic shock with disseminated intravascular coagulation (DIC), which was already marked on admission to the intensive care unit, could not be overcome despite appropriate shock treatment. The pathogenetic spectrum includes more than 70% pneumococci, but any pathogen can trigger an overwhelming postsplenectomy infection (OPSI) syndrome. ⋯ An emergency passport is appropriate. 4. In view of the few side effects of the vaccine, all splenectomized patients should be immunized against pneumococci. Children under 2 years of age should furthermore receive prophylactic oral penicillin up to the age of 5.
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Randomized Controlled Trial Clinical Trial
[Preoperative normvolemic hemodilution in heart surgery. Pulmonary changes with the use of new technics].
Interest in preoperative hemodilution (HD) has intensified perceptibly again, because of the increasing risk of adverse reactions to donor blood. However, in coronary surgery patients the use of HD is still the subject of controversy, as it may possibly influence organ function and especially lung water content. New techniques, including membrane oxygenation, extracorporeal circulation (ECC) with only "partial" bypass due to 2-stage cannulation, and hemoconcentration with cell separators, have significantly modified patient management in the field of cardiac surgery. ⋯ Starting from comparable baseline values, EVLW was not significantly changed by hemodilution. After ECC, however, the HD-RL group showed a significant increase in lung water content (means: +2.49 ml/kg equal 42.6%), whereas this was not significantly changed in the other groups. By 5 h after ECC, the lung water content had returned to baseline values and no more differences could be observed between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)