Der Anaesthesist
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Randomized Controlled Trial Clinical Trial
[Investigations on epidural morphine. Efficacy, solvent, analgesic supplementation].
The effects of epidural morphine for pain relief after orthopaedic surgery of the lower extremity were examined in 60 patients. Intraoperative analgesia was achieved with epidural administration of 2% mepivacaine. The patients were divided in a double-blind, random fashion into 3 groups. ⋯ The solution (glucose or normal saline) had no influence on morphine effectiveness. The side effects were urinary retention in 8 patients (20%) and pruritus in one (3%). It is concluded that 2 mg of morphine base administered epidurally is an effective method of postoperative pain relief in orthopaedic patients.
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In a prospective study infusions of 3,5% isocyanate crosslinked polypeptide solution 500 ml (Haemaccel 3,5%) were given to patients with gastro-intestinal-bleeding for shock treatment and prophylaxis. The increase in intravascular volume was always satisfactory. We did not see any undesirable side effects (anaphylaxis, anaphylactoid reaction, coagulopathy, oliguria).
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A severe shock is produced in 18 mongrel dogs by standardized bone trauma and haemorrhagic shock. Impairment of microcirculation is demonstrated by acidosis, reduced oxygen uptake and disseminated intravascular coagulation (DIC). ⋯ However increase of pulmonary vascular resistance is unchanged and pulmonary haemorrhage is pronounced. Therefore heparin pretreatment enhances pulmonary histologic impairment after trauma and haemorrhagic shock.
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Thirty adult patients were intubated with the help of a flexible fiberoptic instrument (FOI). The endotracheal tube was passed through the right nostril as in blind nasal intubation. At the same time the FOI was passed through the left nostril. ⋯ By this means, it was also possible to alter exactly the position of the tube visually. This procedure presents distinct didactic advantages and helps to prevent false positioning of the tube and subsequent injuries. Indications, in particular its potential use in paediatric anesthesia, as well as its disadvantages, are discussed in the conclusion of this paper.
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Randomized Controlled Trial Clinical Trial
[A new indicator to determine the optimal PEEP (author's transl)].
To elucidate the optimal PEEP for respiratory treatment, respiratory and haemodynamic studies were performed on 12 normovolemic patients with ARDS for various levels of PEEP (PEEP = 0, 5, 10, 20 cm H2O). In this study, it became clear, that Suter's best PEEP (maximal O2 transport should be taken as a reference for optimal PEEP) cannot be used in practice because O2 transport is usually maximal in ZEEP (PEEP=0) and changes with the alteration of FIO2. We propose "intrapulmonary nonshunt flow ((Qt-Qs)" as a new indicator to determine the optimal PEEP. The level of PEEP to achieve the maximal intrapulmonary non-shunt flow must be such that the decrease in intrapulmonary shunt flow is attained with minimal decrease of cardiac output.