Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Plasma cortisol in experimental anesthesia with halothane, enflurane, isoflurane and nitrous oxide].
The influence of anesthesia on plasma cortisol has most often been studied in connection with routine operations. To investigate the specific effects of modern inhalation anesthetics more accurately, we examined the specific effects of four inhalation anesthetics on human plasma cortisol during volunteer studies on the influence of anesthetics on the electroencephalogramm. METHODS. ⋯ Blood samples were taken 5 min prior to induction (I), after the attainment of steady-state MAC 1.0 (II), 35 min later at MAC 0.5 (III), 40 min later at MAC 1.0 with volatile anesthetic/N2O (IV), and 15 (V) and 35 (VI) min after the end of anesthesia. RESULTS. MAC 0.5 N2O produced a marked rise in mean plasma cortisol, from 64.2 micrograms/l to 164.5 micrograms/l.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cardiovascular arrest may be followed by severe respiratory insufficiency due to an increase in the pressure in the pulmonary vascular system, an alteration in capillary permeability, or both. Extracorporeal circulation (ECC), on the other hand, can lead to a change in capillary integrity ('capillary leakage') caused by the unphysiologic perfusion patterns and/or activation of various mediator systems. Pulmonary hyperhydration (increased extravascular lung water [EVLW]) seems to be the most important factor limiting pulmonary function in this situation. ⋯ After ECC a transient increase in EVLW could be demonstrated in the controls, indicating an altered fluid flux even in 'uncomplicated' courses; 5 h after ECC lung water content had again reached baseline values. In contrast, there was a significant increase in EVLW in the 'complicated group' immediately after ECC (+2.60 ml/kg) and 5 h after ECC (+1.38 ml/kg); in consequence, the paO2 was significantly decreased (-180 mmHg) while Qs/Qt was increased (+6.79%). It is concluded that the combination of two factors that potentially damage pulmonary tissue and increase lung water content (reanimation due to circulatory arrest and extracorporeal circulation) lead to a significant increase in extravascular lung water combined with a deterioration of pulmonary function, resulting in severe respiratory failure.
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Results of IV calcitonin treatment in patients suffering from postoperative phantom limb pain (n = 12) or causalgia following peripheral nerve lesions (n = 4) are reported. All patients were complained of severe pain after a traumatic event or amputation, with disturbed sleep in many cases. After only 1-2 infusions 10 patients with phantom limb pain (83%) were discharged from hospital pain-free. ⋯ Recurrent pain due to causalgia could not be improved by repeated calcitonin infusion, although this was effective for phantom limb pain. The administration of calcitonin IV can be recommended as a valuable treatment for phantom limb pain and causalgias in the early postoperative period. Therapy was effective with negligible side-effects, and long-term follow-up revealed a long-lasting effect.
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Patient-controlled analgesia (PCA) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery. Buprenorphine doses of 40 micrograms each were available whenever the patients felt pain relief necessary, and were delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer). ⋯ The effectiveness of PCA was judged superior by about 93% of patients when compared with previously experienced postoperative analgesia. Side-effects (sweating, nausea, emesis) occurred in about 10% of cases but were usually of minor intensity. No circulatory or respiratory problems were observed during the PCA period.
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Understanding the mismatching of ventilation and perfusion (VA/Q) is of special interest in the intensive care setting because - given a stable cardiac output and a given inspiratory oxygen fraction - it allows one to explain certain essential respiratory problems in critically ill patients, namely hypoxemia and hypercarbia. Several different methods are available today for the evaluation VA/Q mismatching. Analysis of the PCO2 and PO2 in arterial and mixed venous blood and mixed expired gas yields information about the quality and the degree of the mismatching present. ⋯ The multiple inert gas elimination technique permits virtually continuous ventilation-perfusion distributions to be described over the whole range of VA/Q ratios and has contributed to explaining the pathophysiological mechanisms in various pulmonary diseases. This method, however, is technically very complex and hence will remain a sophisticated investigational tool. Scintigraphic approaches allow the description of regional topographic VA/Q distributions, but their application is still difficult in the intensive care setting.