Der Anaesthesist
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We report the case of a 4.9-year-old boy with congenital hydrocephalus and obstruction of his shunt who just after the induction of anaesthesia suddenly developed generalized muscle rigidity that made intubation impossible. Because of temporary mydriasis the situation could hardly be differentiated from acute cerebral herniation. The lack of any decrease in muscle tone after emergency trephination and drainage of the right lateral ventricle and the immediate improvement following intravenous dantrolene left no doubt about the diagnosis of malignant hyperthermia. ⋯ Reconstruction of the course of the first anaesthetic necessary for shunt implantation at the age of 62 days revealed that the same symptoms already had occurred. However, they then were not attributed to malignant hyperthermia but interpreted as symptoms of acute herniation. A detailed description of this first anaesthetic is given which again elucidates the problems associated with the abrupt onset of muscular hypertonus in a patient with neurologic disorder; moreover this may well be the first published case report of malignant hyperthermia at the age of just 2 months.
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Haemodynamic and metabolic effects of glucose-potassium-insulin (GKI) were studied in 14 patients with peritonitis. Study entry criteria were: hypodynamic septic shock (mean arterial pressure less than 50 mmHg and cardiac index less than 3.5 l/min) despite a highly positive fluid balance (greater than +2,000 ml during the last 12 h) and use of catecholamines (greater than 15 mcg/kg/min Dobutamine). GKI (glucose 70% 1 g/kg + potassium 10 mval + insulin 1.5 U/kg) was infused within 15 min via a central venous catheter. ⋯ The haemodynamic improvement lasted from 30 min or less (n = 3; 21%) to several hours. Nine patients (64%) survived more than 2 days, and two patients (14%) were eventually discharged from the hospital. We conclude, that in hypodynamic septic shock refractory to volume loading and catecholamine treatment GKI may be beneficial, although the mechanism of action remains unclear.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol in comparison with etomidate for the induction of anesthesia].
In the present study propofol and etomidate were compared with respect to the effects on the cardiovascular system and its side effects in 100 patients ASA grade I-IV. Anaesthesia was induced with 2.2 mg kg-1 body weight propofol. Supplemented with opioids and benzodiazepins the dose diminished to 1.8 mg kg-1 body weight (18.2%). ⋯ Pain on injection was frequent but thrombosis and phlebitis were not observed. There was a considerably lower incidence of postoperative nausea and vomiting compared with etomidate. The investigators concluded: propofol can be recommended for induction of anaesthesia as an alternative to etomidate.
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Randomized Controlled Trial Clinical Trial
[Lung compliance in man is impaired by the rapid injection of alfentanyl].
To demonstrate opioid-induced muscular rigidity, compliance was measured in patients after induction of anaesthesia with etomidate (0.3 mg/kg) and N2O/O2 (2:1) ventilation. Alfentanil was given subsequently to two groups of patients: either as a bolus injection (n = 15) over 3 s, or as a slow injection (n = 15) over 30 s. Significant reduction of compliance (max. 30%) was observed after rapid injection in the following 4 min. ⋯ The slow injection of the opioid over 30 s, was followed by a small insignificant reduction in compliance. Alfentanil is increasingly used for short-term anaesthesia where no muscle relaxants are administered. Thus slow injection of the opioid is advised in order not to impair adequate ventilation.
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Historical Article
[The history of endotracheal anesthesia, with special regard to the development of the endotracheal tube].
Endotracheal anaesthesia is today the form of general anaesthesia most often applied. It represents more than 80% of the total in hospitals with different surgical specialties. ⋯ At the beginning of our century all preconditions had been given for a widespread and safe performance of endotracheal anaesthesia. The most important stages in the development of this form of anaesthesia are as follows: 1869: First endotracheal anaesthesia in human by use of a tracheotomy cannula by Friedrich Trendelenburg. 1880: First orotracheal intubation anaesthesia by William Macewen. 1894: Positive pressure ventilation following morphine intoxication by George Fell and Joseph O'Dwyer. 1895: Description of direct laryngoscopy by Alfred Kirstein. 1901: Franz Kuhn "Die perorale Intubation".