Der Anaesthesist
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Severe intubation injuries of the larynx and trachea are usually caused by prolonged intubation, particularly if the primary intubation was difficult. Due to the persisting, time-consuming therapeutic problems, tracheal and laryngeal stenoses are among the most-feared sequelae of long-term intubation. Therefore many laryngologists reject endotracheal intubation for prolonged respiratory support and recommend an early tracheostomy. Advances in respiration techniques and in the development of tissue-compatible tubes with low pressure cuffs permit, in our opinion, prolonged intubation if this is controlled by repeated endoscopic examination to recognize lesions at an early, still reversible, stage.
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A new formula for solution of etomidate has been studied. Like other lipophilic drugs etomidate may be dissolved in a non-irritating oil emulsion and used for intravenous injection. Etomidate in Intralipid was compared as induction agent with etomidate in glycolic solution (Hypnomidate) and with methohexitone (Brietal). No pain on injection occurred when etomidate/Intralipid was used.
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The increase of blood lactate is a well known side effect of active and passive hyperventilation. In 22 patients who underwent controlled respiration after head injury or elective neurosurgical operations, we measured lactate, pyruvate, pH, and bicarbonate in central venous blood and investigated their interference by hypocapnia. The level of ventilation was between pCO2 equal 25 mmHg and pCO2 equal 45 mmHg, measured in the central venous blood. ⋯ At a pCO2-range of 25-27 mmHg (central venous) lactate continued increasing to 2.212 +/- 0.995 mMol/l whereas pyruvate dropped to 0.087 +/- 0.05 mMol/l. Therefore the possibility of hypocapnia-induced lacticemia seems to arise at a ventilation level less than 30 mmHg (pCO2 central venous). Production of excess-lactate may begin at a central venous pCO2 of 27 mmHg.
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Polygeline (haemaccel 35 Behringwerke) was tested in 1147 patients in a prospective and multicentre study facing systemic anaphylactoid or cutaneous anaphylactoid side effects. 8 patients showed mainly cutaneous reactions (redness and itchy swelling) and only one an increase of ventilating pressure during anaesthesia (0.78%). Polygeline showed according to an improved preparation unexpected reactions only of the cutaneous anaphylactoid type (no severe systemic life threatening reaction, histamine liberation 1 ng/ml or less according to Lorenz).
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Environmental contamination with bacteria in the course of extubation was shown to be minimal as compared to contamination of the hands and gowns. 7 out of 21 anaesthesiologists were carriers of staphylococcus aureus. Two persons spread staphylococci to their patients and the operating room environment in spite of strict adherence to conventional hygienic policies.