Der Anaesthesist
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After breaking through thin ice, a 4-year-old boy drowned in a lake. A quickly alerted rescue helicopter found and recovered the child, drifting underneath the clear, thin ice. Primary resuscitation by the helicopter crew was unsuccessful. ⋯ The patient had to be kept on the ventilator for 10 days and after another 2 weeks was discharged home. He had recovered completely without any cerebral damage. One of the reasons why 88 min of cardiac arrest were tolerated by this patient without sequelae may have been rapid and deep hypothermia.
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An unexpected, potentially hazardous complication during the use of Robertshaw double-lumen endobronchial tubes is reported. A material defect causing obstruction of the lumen made endotracheal suction during surgery impossible even with very thin suction catheters. The authors recommend the internal diameter of double-lumen endobronchial tubes checking before intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Onset of the effect and intubation conditions following atracurium, verocuronium and suxamethonium].
1. The onset of neuromuscular blockade following i.v. injection of atracurium 0.3, 0.4, or 0.5 mg/kg; vecuronium 0.08 or 0.1 mg/kg; and succinylcholine 1.0 mg/kg was studied in 205 adult patients during induction of anesthesia by means of the compound action potential (EMG) of the hypothenar muscle, which was indirectly stimulated via the ulnar nerve above the wrist, using the Datex Relaxograph. At the same time, the intubation conditions at 0.5, 1, 2, or 3 min after injection were assessed using a scoring system (Crul 1983) related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of the extremities. 2. ⋯ Motor blockade 1 min after succinylcholine was 98 +/- 2% and intubation conditions scored 11.3 +/- 0.3. Relating intubation conditions to neuromuscular blockade yielded a close correlation and surprisingly good or very good intubation conditions (score more than 10) at a motor blockade of 80% (resp. 20% transmission). 3. Although succinylcholine is still the muscle relaxant with the most rapid onset of action, the new drug atracurium seems to satisfactorily facilitate tracheal intubation within an acceptably short time interval of 2 min after injection.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
[Warming resuspended erythrocyte concentrates with a new microwave device. In vitro results and clinical experiences in comparison with continuous flow warming].
Rapid warming of stored red cell concentrates demands a technique that provides careful treatment of the erythrocytes, reliability, simple handling, and prompt processing. The Fenwal BW-5, a dry-heat blood warmer, is a well-established blood heating device. However, its use is time-consuming and rather complicated. ⋯ DISCUSSION. From the literature, it is known that the erythrocytes of full-sized blood units with normal hematocrit are not damaged by microwave warming. In contrast, small blood units and undiluted packed red cells revealed considerable hemolysis and distinct changes in MCV and osmotic fragility.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Clinical Trial
[Propofol infusion for the maintenance of short-term anesthesia].
The administration of propofol by infusion for maintenance of anesthesia has attracted much attention recently. We investigated the necessary infusion rate of propofol to maintain anesthesia for short surgical procedures without loss of the evident advantages of this substance. Forty unpremedicated female patients aged 18-59, scheduled for minor gynecological procedures, were randomly assigned to four groups. ⋯ After induction, arterial blood pressure decreased by systolic/diastolic 20/10-15 mmHg. With the low infusion rate, arterial pressure increased to its control value during operation; it remained at the postinduction value with high infusion rates. Side-effects: 10 patients had salivation that in some instances lead to coughing, 9 reported pain at the injection site during induction, and 9 reported dreams of a pleasant nature.(ABSTRACT TRUNCATED AT 250 WORDS)