Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[The effect of intraoperative PEEP ventilation and postoperative CPAP breathing on postoperative lung function following upper abdominal surgery].
The problem of how to improve postoperative pulmonary function after upper abdominal surgery was investigated in a randomized study involving 64 patients who were subjected to various treatment regimens designed to increase airway pressure. Intraoperative ventilation was carried out with either zero or positive end exspiratory pressure, and postoperatively either CPAP or a nasal oxygen catheter were applied. The following groups were formed: 1. ⋯ The typical reduction in vital capacity occurred postoperatively, the lowest value being recorded on the 2nd postoperative day, an alteration in respiratory pattern with reduced tidal volume and increased respiratory rate together with an initially low, later normal alveolar ventilation, and an initial hypoxaemia which was at first associated with a moderate hypercapnia, on the second postoperative day with a normocapnia, were observed. At no point in time could a difference be found between the 4 groups, no measurable improvement in respiratory function being found as a result of the treatment given. Intra- and post-operative increase in airway pressure was however found to be associated with a reduction in the incidence of post-operative pulmonary complications.
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The remarkable development of computer technology and the early experiments into its clinical use give us cause ot define useful spheres of application and task areas in anaesthesia for this valuable machine. Parallel to this followed the development of computer use in anaesthesia. Here, there are essentially four main areas of application: administration of data, monitoring, teaching, process of decision making. ⋯ For the application of computer technology in the practice of anesthesiology it is essential to guarantee not only sufficient safety of data but also a protection from misuse and manipulation. On the whole it is probable that computer technology will take over more and more medical technical tasks especially of the anaesthesia apparatus and evaluate them. An automatic registration of records with combined off-line and on-line recording of measured values represents the logical development of this technology.
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13 cases of severe cerebral trauma were subjected to varying degrees of elevation of the upper trunk (0 degrees, 15 degrees, 30 degrees, 45 degrees) and to head-raising only (0 degrees, 15 degrees, 30 degrees). The intracranial pressure and mean arterial pressure were measured in these positions. On raising the upper half of the body by 15 degrees, intracranial pressure fell from a mean of 35.3 mm Hg to 28.7 mm Hg, and to 25.2 mm Hg on raising to 30 degrees. ⋯ In contrast, the mean arterial pressure fell constantly as elevation increased, resulting in a decrease in cerebral perfusion pressure at levels above 30 degrees. In no cases did raising of the head alone result in a lowering of pressure. Instead, potentially dangerous increases were observed.
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This study compares the effect of epinephrine (11 dogs) with that of the combination of epinephrine with calcium (10 dogs) in CPR after anoxial cardiac arrest. In the epinephrine group resuscitation was successful in all 11 dogs within 4 minutes. ⋯ In the survivors of the calcium group cardiac function was significantly impaired: 1. decreased left ventricular pressure (LVP) and contractility (dp/dt max), 2. increased afterload, 3. decreased cardiac output inspite of increased heart rate, 4. as a consequence, reduced perfusion of the vital organs. - These results foster the conclusion that calcium should not be used henceforth in CPR. Epinephrine was and is still the drug of choice in resuscitation after cardiac arrest.