Der Anaesthesist
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In 55 polytraumatized patients blood clotting tests were performed and analyzed in relation to the severity of the injuries and traumatic-hemorrhagic shock and the amount of homologus blood transfused. The degree of the changes of the clotting parameters was found to depend mainly on the severity of shock. The amount of transfused blood had of no influence. The results indicate the importance of an early i.v. fluid therapy corresponding to the demand of volume and the replacement of blood lost by haemorrhage.
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The cardiocirculatory responses to equianaesthetic concentrations (MAC 0.5 and MAC 1.0 plus 67% N2O) of halothane, methoxyflurane, enflurane and isoflurane were studied in a total of 35 closed-chest dogs during ventilation controlled to produce normocapnia. Each anaesthetic produced a dose-related decrease in mean arterial pressure and in values reflecting cardiac function. These included cardiac output, stroke volume, left ventricular max dp/dt and ejection fraction. ⋯ Parallel with the depression in cardiac performance and blood pressure as two of the main predictors of energy demand, myocardial oxygen consumption was found to be significantly reduced by each of the anaesthetics. The ratio of the external work of the left ventricle to its oxygen consumption indicated that myocardial efficiency deterioated. The clinical implications are discussed.
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Apgar status and acid base balance of 206 neonates, delivered by caesarean section under general anaesthesia, were investigated in order to compare the possible effects of either thiopentone- or ketamine-induction on the postpartum adaption. Several other criteria were recorded also, for instance, a possible neonatal asphyxia, the induction-delivery-interval, the maternal age, the administration of other than anaesthetic drugs etc. There were not correlations between the Apgar status and the induction-delivery interval in either groups. ⋯ The blood gas values and the acid base parameters did not show a statistically significant difference between the pH of the thiopentone- and the ketamine-neonates. These differences can be explained as the combination of the nonsignificant changes in PCO2 and standard-bicarbonate values. As far as can be judged from the above mentioned criteria it may be deduced that ketamine or thiopentone can equally well be used for inducation of anaesthesia for caesarean section.
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In young patients with healthy lungs, the effects of ethrane and halothane on compliance and resistance have been investigated. With the use of ethrane we found a dose-dependent decrease in compliance, but this decrease was statistically assured only at relatively high inhalation concentrations. ⋯ The decrease in compliance induced by both anesthetic agents may be due either to interference with the surface tension of the alveolar wall, or to transitory changes in the fluid content of the pulmonary parenchyma. For the practical use of ethrane and halothane no significant differences appear to exist on the basis of their effects on compliance and resistance.
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Case Reports
[High spinal anaesthesia following intrathoracic intercostal nerve block. Report of a case (author's transl)].
In a 59-year-old female, anaesthetized with halothane, nitrous oxide/oxygen, intercostal nerve blocks were performed after right lateral thoracotomy. Before closure of the chest four segments were blocked each with 3 ml 0.5% bupivacain (Marcain, Carbostesin) without adrenaline. ⋯ The patient was able to be extubated 90' after the last block and there were no further complications. The possible mechanism of producing spinal anaesthesia after peripheral nerve blocks and the necessary precautions to avoid this complication are discussed.