Der Anaesthesist
-
The method of extracorporeal CO2-elimination (ECCO2-R) as described by L. Gattinoni [2] and Kolobow [5] is reported in ten patients with severe ARDS in whom conventional respirator therapy had failed. The method itself as well as important pulmonary function parameters, e.g. changes in gas exchange (Fig. 3), extravascular lung fluid (Fig. 6), and chest radiographs are explained. ⋯ In the responders, oxygenation improved and the intrapulmonary shunt Qs/Qt (Fig. 4) decreased, followed by extravascular lung water and mean pulmonary arterial pressure (Fig. 5). Towards the end of the therapy we could find normalization of the compliance (Fig. 7) and chest X-rays, which may be interpreted as a cure. The results confirm our theory that ECCO2-R in combination with high PEEP and low-frequency ventilation seems to be an important method for future therapy of acute pulmonary failure.
-
After transnasal placement of a tracheal and a gastric tube, the latter did not function properly. Several attempts to remove the gastric tube were unsuccessful, but this could not be explained on several laryngoscopic inspections. The palpating finger finally found a knot of tracheal and stomach tubes high in the epipharynx. This incident underlines the importance of faultless functioning of tracheal and stomach tubes, especially in patients with intended intermaxillary fixation.
-
Case Reports
[Heart dislocation following extensive lung resection with partial pericardial resection].
Cardiac herniation is a rare but dramatic complication of pulmonary resection that demands urgent treatment. About 50 patients have been reported in the literature; 50% of them died. Symptoms vary depending on the location of the pericardial defect. ⋯ Often dramatic deterioration in the patient's status may not allow time for diagnostic procedures. In case of doubt, immediate rethoracotomy is indicated. In the case observed, a 47-year-old woman underwent right pleuropneumonectomy with partial pericardectomy and intrapericardial ligation of the pulmonary vessels.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Intraoperative neuromonitoring, especially evoked potential monitoring, has gained interest in recent years for both the anesthesiologist evaluating cerebral function and the neurosurgeon wishing to avoid neuronal lesions during intracranial operations. Before evoked potential monitoring can be introduced as a routine method of intraoperative management, experience with this method particularly in intensive care units, is imperative. We recorded evoked potentials with the Compact Four (Nicolet) and Basis 8000 (Schwarzer Picker International) computer systems. ⋯ In these cases SSEP monitoring could be carried out. Despite these difficulties, evoked potential monitoring seems useful. We believe, however, that it is not routinely used in operating rooms at present because alterations of the responses can be due to different causes; for the neurosurgeon, the problem as to which interdependent degrees of alteration in evoked potentials are related to neuronal disturbances remains unsolved.
-
The effects of Disoprivan on cerebral blood flow (CBF), cerebral oxygen consumption, and CO2-reactivity of the cerebral vessels were studied in 11 male patients between 49 and 63 years of age who were about to undergo coronary artery bypass surgery. Mean perfusion pressure was decreased by 25% under anaesthesia by 0.2 mg/kg per minute Disoprivan, but remained within the ranges of autoregulation. ⋯ Hypoventilation was followed by a 67% increase in CBF and a 44% decrease in CVR cerebral oxygen consumption was decreased by 38%. This study shows that the reactivity of the cerebral vessels to changes in paCO2 is well maintained under Disoprivan.