Der Anaesthesist
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Spontaneous respiration in the presence of upper airway obstruction causes considerable negative intra alveolar pressure which may lead to pulmonary oedema "ex vacuo". Four cases are presented of spontaneously breathing patients who sustained upper airway obstruction lastin from one to several hours, leading to manifest pulmonary oedema. The pathogenesis of pulmonary oedema ex vacuo is discussed on the basis of alteration of physiological parameters such as capillary, alveolar and pleural pressures, as well as the properties of lung liquid exchange. ⋯ No negative intraalveolar pressure could be incriminated in this case since the patient was ventilated using intermittent positive pressure from the beginning of lung expansion. We tend to attribute the evolution of this second kind of pulmonary oedema to capillary damage, resulting from hypoperfusion of the atelectatic areas, altered alveolar surface lining layer, infection and other cases. The therapeutic measures used in pulmonary oedema "exvacuo" are briefly mentioned.
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A simple method of diverting anaesthetic waste gases from the Engström ECS-2000 ventilator is described. Unless special precautions are taken the digital volume measurement may be influenced; the simple solution of this problem is given.
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After successful rescue from drowning there may develop a situation which is called secondary drowning, resulting in acute respiratory distress characterized by interstitial pulmonary oedema, hypoxaemia, hypercapnia and acidosis during drowning, direct alteration of the alveolar membrane by aspirated water and particulate matters and a volume overloading by adsorption and--not seldom--inept therapy. This situation requires mechanical ventilation and forced diuresis, combined with high doses of steroids, antibiotics and digitalis. ⋯ After development of acute respiratory distress only the immediate utilization of the therapeutic modalities of an intensive care may result in a satisfactory outcome. Four months later our patient had normal pulmonary function except for a moderate reduction of compliance.
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The heart rate of anaesthesiologists under defined physical and psychological stress as well as during normal anaesthetic practice was studied. An acceleration of heart rate during induction and management of anaesthesia did not occur except in the presence of complicating circumstances. A phone call or a beeper alarm led to a rather ergotropic heart rate reaction (increase of 21%), especially when sleep was interrupted (increase of 75%). ⋯ However an increasing tolerance was seen with growing experience. Physical and psychological stress during the anaesthesiologist's work could be differentiated by means of heart rate except in some single observations. In the presence of both stressing factors the heart rate seems to be determined by the motor effort required.