Der Anaesthesist
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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.
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A new module of the Dräger modular device system provides a means for demand CPAP (to increase FRC) and assisted spontaneous breathing. Both features together may largely increase the potency of ventilatory therapy for spontaneously breathing patients. The machine may reduce the need for full ventilatory support in acute respiratory failure, but also provides a valid and rational tool for respiratory therapy.
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The present conditions of the anaesthesiologist's workplace are characterized by completely unacceptable circumstances, incompatibilities, inflexibility and unsafeness. Like inadequate cockpit conditions in airplanes, these workplace conditions pose considerable risks to the safety of patients and personnel. Taking into consideration the literature and our own views, we have proposed some changes which are essential for improving the working conditions of anesthesiologists: Ergonomic improvements of the anaesthesiological workplace in order to facilitate the anesthetist's performance, to provide him with adequate space, and to automatize repeated and relatively unimportant activities. ⋯ The most useful alternative to the present conditions would be to locate the information panels of primary and secondary monitoring devices to the immediate right, or on the right- und left-hand sides of the anesthetist at an angle of 15 degrees-30 degrees each. Furthermore, these information panels should be arranged so that they can be monitored using moving and slightly tilted screens. The most important of the patients, clinical parameters as well as the functions of the equipment should be monitored by alarms, warning devices, or simply indicators, which can easily be separated.(ABSTRACT TRUNCATED AT 250 WORDS)
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The role of stress ulcer prophylaxis in increasing the risk of pneumonia in ventilator patients was analyzed prospectively in 142 artificially ventilated patients at a medical and surgical intensive care unit (104 males, 38 females, mean time of ventilation 7.9 days, mean age 46.5 years). The pH of gastric aspirate and bacterial counts in gastric fluid and tracheal secretions were investigated daily. Identical isolates from gastric aspirates and tracheal secretions were typed by agglutination, bacteriocin, or phage typing. ⋯ Only 20% of all migrations of Gram-positive organisms from stomach to respiratory tract lead to pneumonia, as compared with 60% of Gram-negatives. At a gastric pH below 3.4 the incidence of ventilation pneumonia was 40.6%; above pH 5.0 the incidence was 69.2% (P less than or equal to 0.05). As pH increased, the organism causing pneumonia was significantly more often isolated first from the gastric aspirate and 1 to 2 days later from the tracheal secretion of the same patient.