Der Anaesthesist
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Case Reports
[Permeability pulmonary edema (neurogenic pulmonary edema) following isolated head and brain injury].
This paper reports on 3 patients with permeability pulmonary oedema accompanying an isolated head injury (neurogenic pulmonary oedema - NPE). The occurrence of a NPE in our patients with isolated head injury amounts to 0.62%. Comparing our case reports and results, respectively, with those published in the literature, the pathogenesis of NPE is discussed and delineated.
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There is an increase in endotracheal tube-cuff volume and pressure due to nitrous oxide diffusion into the cuff during anaesthesia. A rise of the cuff pressure up to 100 mm Hg (high volume-low pressure cuffs!) within only two hours is nothing out of the ordinary. The inspiratory nitrous oxide concentration influences the cuff pressure rises. ⋯ In endotracheal tubes with a Rediffusion System, cuff pressure never exceeds capillary perfusion pressure of the tracheal mucosa. In our in vitro-experiments we found an increase of cuff pressure from 14.2 +/- 0.5 mm Hg to only 27.3 +/- 1.9 mm Hg within six hours (FIN2O = 0.66). Within 150 minutes of endotracheal anaesthesia (FIN2O = 0.66) cuff pressure rose from 14.6 +/- 0.5 mm Hg to only 21.5 +/- 3.6 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
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Historical Article
[The Braun apparatus for mixed ether-chloroform anesthesia. A contribution to the early history of combination anesthesia].
The Braun ether-chloroform vaporiser was very frequently used during the first fifty years of the 20th century, mainly in the German speaking region. This primacy was principally involved by the simple management, the universal possibilities of application and the "expedient" combination of ether and chloroform: this term means the differential employment of these two substances for conducting individual anaesthesia. Heinrich Braun had published his method after extensive experimental studies, here briefly referred to; further reasons for the considerable success of the apparatus are discussed.
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Randomized Controlled Trial Clinical Trial
[Ranitidine (Zantic) for aspiration prevention].
The new H2-receptor antagonists have been shown to be effective against the risk of gastric acid aspiration. The recommended dosage schedules, however, are not satisfactory in a clinical routine practice. Therefore the effect of the long acting agent ranitidine on pH and volume of gastric secretion after a single administration at 22.00 h on the previous evening has been investigated. ⋯ Ranitidine 150 mg and cimetidine 400 mg are not satisfactory, as expected. If an anaesthetic is scheduled to start later than 09.00, an additional dose of ranitidine should be administrated at 07.00. Ranitidine 300 mg provides an efficient prophylaxis against acid aspiration in one single dose and without additional medications at a time inconvenient for patient and nursing staff.
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Comparative Study
[Orciprenaline (Alupent) in resuscitation for circulatory arrest? Experimental comparison between orciprenaline and adrenaline in dogs].
This study compares CPR with orciprenaline (8 dogs), with epinephrine (11 dogs) and without any drug (8 dogs) in cardiac arrest caused by anoxia. Resuscitation was successful in all animals of the epinephrine group and in 2 of the orciprenaline group. Spontaneous circulation could not be restored in any of the control animals. ⋯ The superiority of epinephrine was due to its having effected a significantly higher diastolic pressure during cardiac massage. The diastolic pressure decreased after orciprenaline injection to such an extent that coronary underperfusion resulted with consequent rise of serum CPK. We conclude that the use of orciprenaline is contraindicated in cardiac arrest.