Der Anaesthesist
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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.
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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 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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We examined the reproducibility of the results of extravascular lung water measurements obtained by the double indicator dilution method. The coefficient of variation (delta) for 82 EVLW-measurements was 13 +/- 8%. ⋯ Our results suggest that the important coefficient of variation of the EVLW-measurements is overall due to the variability of the difference between the 2 transit times measured. The temperature exchange between the intravascular cold bolus and the extravascular thermal volume is flow dependent especially at high EVLW-values.
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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".