Der Anaesthesist
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Following anaesthesia with halothane and succinylcholine, a 56-year-old patient relapsed into unconsciousness which was accompanied by an increase of body temperature to 42 degrees C and further symptoms indicative of malignant hyperpyrexia (MH). Although a diagnosis of MH could not be established, during subsequent anaesthesia, the patient was treated as an individual susceptible to MH. The problems of this policy and the need to elucidate the susceptibility to MH are discussed with reference to this case.
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Accidental thermal damage in case of explosion and fire caused by laser-surgery is a well-known problem and still not solved. A combination of laser beam, oxygen and inflammable substances are only one aspect. ⋯ An incidental observation during one case of endotracheal tube-fire led to some fundamental considerations. With a modified PEEP-ventilation hazard can not be prevented, but limited in its complications.
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A new noninvasive cardiac output (CO) computer ("NCCOM 3") based on the bioimpedance principle was compared to a CO computer based on standard thermodilution measurements. Simultaneous measurements were made on dogs who were ventilated with or without positive end expiratory pressure (PEEP). There was no correlation of cardiac output measurements with the two methods (r = 0.10, n = 60). ⋯ These differences were statistically significant. We conclude that the NCCOM 3 cannot at present replace the invasive standard methods of CO measurement in ventilated patients. A lack of differentiation of circulatory effects, thoracic gas volume, and intrathoracic fluid content is the most likely cause of the discrepancies seen.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of fentanyl and tramadol in pain therapy with an on-demand analgesia computer in the early postoperative phase].
17 patients undergoing cholecystectomy in non-opiate general anaesthesia received tramadol (n = 7) or fentanyl (n = 10) for immediate postoperative pain relief using the on-demand analgesia computer (ODAC). Heart rate, blood pressure, and respiratory rate were monitored at half-hourly intervals during the 6-h trial period. Arterial blood was withdrawn at hourly intervals for blood gas analyses and beta-endorphin plasma level assays. ⋯ Respiratory rate, which was elevated initially, dropped significantly in both groups. Arterial pO2 and pCO2 were within the normal range throughout the observation period, reflecting the absence of respiratory side effects. Opiate blood levels showed major inter- and intraindividual variations (minimal and maximal levels for fentanyl ranged from 0.44-3.44 ng/ml, for tramadol from 272-1,900 ng/ml) and were thus poor predictors of the quality of analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
[Postanesthetic recall ability, anxiety and dreams in surgical patients. A clinical study].
The recall of stimuli registered during general anaesthesia is described. Patients were interviewed 2 days after surgery, concerning their experiences during anaesthesia. ⋯ Of 140 patients, 2 described recall of awareness during anaesthesia. There was no evidence that external stimuli had been incorporated into dream content.