Der Anaesthesist
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When starting controlled ventilation with PEEP, a ventilation within the mid-third of the inspiratory capacity (IC) with a tidal volume (VT) of IC/3 ("primary VT") is recommended, to increase functional residual capacity (FRC) effectively and to avoid adverse haemodynamic effects related to hyperinflation of the lung. The quasi-static expiratory pressure-volume curves (VPE) of 28 patients with acute respiratory failure were graphically analyzed to evaluate the PEEP which could be expected to increase FRC by 1/3 of the IC ("primary PEEP"). the volume by which VT must be reduced, to keep the endinspiratory lung volume constant, if a higher PEEP would be desired. The "primary PEEP" was found to be 12,2 +/- 2,5 cmH2O, thus confirming the clinical practice to use preferentially 10 cmH2O. ⋯ This means that the increase in FRC per 1 cmH2O PEEP in this range can be expressed as a nearly constant fraction of the IC (delta FRC/ delta PEEP = IC/32). Hence, to avoid endinspiratory hyperinflation of the lung, it is recommended to reduce the "primary VT" by IC/32 or, which means the same, by VT/10 per 1 cmH2O PEEP exceeding 10. If, however, a ventilatory pattern has to be chosen with respect to gas exchange, where hyperinflation cannot be excluded, this should be done under close haemodynamic control using a Swan-Ganz catheter.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The significance of tramadol as an intraoperative analgesic. A randomized double-blind study in comparison with placebo].
Tramadol-N2O anaesthesia as recommended by Stoffregen was studied in 40 patients (ASA I-II) undergoing elective orthopaedic or lower abdominal surgery. Fentanyl and droperidol (Thalamonal)/atropine were given as i.m. premedication, induction was performed using methohexitone, succinylcholine and pancuronium, ventilation was controlled by means of a Takaoka respirator (N2O/O2 79:21, 4 breaths/min). Intraoperative analgesia was provided by a biphasic tramadol infusion. ⋯ When enflurane had not been necessary (tramadol n = 13, placebo n = 10), mean percentage rises of blood pressure or pulse rate, related to preoperative values, were found to be slightly higher in the tramadol group. Postoperative analgesic requirement was reduced significantly after tramadol. Striking differences between the two groups, on the other hand, were shown with respect to intraoperative awareness: while patients receiving placebo proved to be amnaesic, 65% of tramadol patients were aware of intraoperative music.(ABSTRACT TRUNCATED AT 250 WORDS)
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The customary use of standardized regimens for heparin anticoagulation and its neutralization by protamine in cardiopulmonary bypass may result in gross over- or underdosage of either substance with resulting clinical problems. Heparin and protamine doses, postoperative blood loss during the first 20 h and the need for bank blood in a group of 100 patients following a fixed heparin-protamine protocol were compared with another group of 106 cases with ACT-guided heparin and protamine dosage. ⋯ The mean postoperative blood loss in the ACT-cases was 4.54 ml/kg/20h, 2.29 ml respectively 33.5% less than that of control group. The demand for bank blood in the ACT-group was 1.97 units opposed to 5.12 units in the standardized regimen group.
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Hearing loss after spinal anaesthesia is very seldom reported in the literature. After having seen such a case we studied prospectively 100 patients with urological operations under spinal anaesthesia. We found 3 patients having a typical picture of a transient hearing loss in the low frequency range (30 dB). This disturbance was reversible in short time without special therapy.
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Case Reports
[Hemothorax caused by injury of the 1st intercostal artery following trial puncture of the subclavian vein].
This article reports the case of a patient who sustained an injury of the intercostal artery after a vena subclavia aspiration with extensive haemothorax. After thoracotomy, haemostatic treatment, respiratory therapy, intensive care and a prolonged hospital stay the female patient was discharged with a clean bill of health.