Der Anaesthesist
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Morphine 2 mg was injected directly into the intrathecal space in 33 patients. In the nonoperative group (group I) morphine was given with 2 ml saline solution; in the operative group (group II, 21 patients) morphine was given with 2 ml 10% glucose solution immediately before induction of anaesthesia. The onset of pain relief occurred after 12 to 35 min and the duration of analgesia was 14 and 18 35 min and the duration of analgesia was 14 and 48 hours. ⋯ In group I bladder insufficiency occurred in 2 cases. The disturbed bladder function recovered spontaneously in a few hours after morphine application. Respiratory depression was treated successfully with naloxone.
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We report on the development of a data collection form for anaesthesia. The difference between this form and the previously published recommendations is that it does not require any coding of data prior to collection. ⋯ Qualitative data have only to be marked, while quantitative data must be entered as such. So far, more than 90,000 anaesthesias have been collected with the form presented, therefore usefulness may be assumed.
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Considering the advantages shown by the experiences of Reynolds on prolonged inspiration time it was suggested to study this type of ventilation also in ARDS. We tried the inverse ratio ventilation (IRV) in patients with ARDS and in postoperative cardiac surgical patients. An obvious improvement of gas transfer in the lung is seen and becomes better with increased duration of this type of ventilation. ⋯ An effect similar to PEEP caused by an air trapping mechanism, can be seen with the shortening of expiration time. This air trapping mechanism is followed by autonomous adaption of PEEP for the local situation in various parts of the lung. A higher PEEP in poorly ventilated areas is automatically adjusted with IRV, than in areas with a short time constant (individual PEEP).
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The obturator reflex is a frequent complication of the transurethral resection of bladder tumors, specially those localized at the side of bladder. The transurethral operation often must be interrupted, or changed into a transabdominal one, because of danger of bladder perforation or severe bleeding. In addition to spinal analgesia two techniques of obturator block are presented and their use is discussed.
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Expectoration of bacterially contaminated mucus during bronchial toilet of artificially ventilated patients can be controlled avoiding heavy contamination of intensive care staff, patients and surroundings. By the use of the Bronchial-Secretions-Guard in combination with the H. R. ⋯ By the use of this setup a reduction of hospital infections in adult patients of the intensive care unit can be expected in a similar way as reported in a early study on premature and newborn babies ventilated only by the H. R. P.-System 2000.