Der Anaesthesist
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Neurological disturbances were seen in patients who underwent open heart surgery with prolonged extracorporeal circulation. These were found mainly in patients older than 50 years and when episodes of hypotension lower than 50 mm Hg occurred during cardiopulmonary perfusion. A method of recognizing cerebral hypoperfusion would be most helpful to prevent brain damage. ⋯ Cessation of the orbital oscilogram during extracorporeal circulation does not indicate a cerebral hypoperfusion. No neurological lesion was seen in our patients. We were able to show that amplitude of the ophthalmodynamogram is influenced more by the blood pressure amplitued than the mean arterial pressure.
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Changes of volume and pressure due to N2O-diffusion into PVC and Latex cuffs of endotracheal tubes were measured. Endotracheal tubes with a small-volume cuff (Magill and Portex) and one type of a large-volume, low-pressure cuff (Lanz) were examined. Within 48 h significant changes of volume and pressure were registered at different starting volumes and different N2O-concentrations. ⋯ In the large-volume cuffs of the Lanz tube there were increases of volume and pressure; the measured pressures where however, in a clinical unimportant range. These changes are caused by N2O-diffusion into the cuff, slowed N2-diffusion out of the cuff, prestretching of the cuff membrane by the starting volume and further stretching by N2O diffusing into the cuff. These measurements are of practical clinical significance: This high-pressures due to starting volume and N2O-diffusion in small-volume cuffs explains the higher rate of trauma to the trachea, even after short term intubation, in contrast to the extremely low pressures in large-volume, low-pressure cuffs.
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Randomized Controlled Trial Clinical Trial
[The influence of different plasma substitutes on blood clotting and platelet function during and after operations (author's transl)].
It has been shown in clinical experiments that plasma substitutes generally have a specific-colloidal influence on special parts of the clotting system. These changes are predominant after infusion of dextran, since on one hand there is an inhibition of platelet function, and on the other hand a decrease in the activity of plasmatic clotting factors. ⋯ These reactions are due to colloid-specific effects only, which have been unknown up to now. Activities of plasmatic clotting factors, however, are not influenced by these substitutes.
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The sitting position of the patient offers many advantages to the neurosurgeon for operations at the posterior fossa, the upper cervical region, the Gasserian ganglion and the retroganglionic trigeminal root. Air embolism is however one of the greatest dangers during operations in this position. ⋯ But early diagnosis and immediate therapy are of utmost importance. The use of an ultrasonic monitoring device for early diagnosis and the preoperative insertion of a right artrial catheter for immediate aspiration of the air are recommended.
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A rare complication following a dural tap in labour is reported: cerebrospinal fluid was aspirated although a catheter was properly re-inserted into the peridural space. The most successful therapy is proposed.