Der Anaesthesist
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In a retrospective study first-aid measures taken in 939 individuals who had died from accidents and the means of transport were investigated. At the scene of accident, emergency medical technicians have been and will in future be the ones to take first measures (43%). Physicians (22%) and untrained persons (20%) alike have been found to attend to victims at about the same frequency. ⋯ In view of the above situation it is, therefore, urged that first-aid training of laymen be organized on a broad scale and that all possibilities of providing instruction be exploited. Emergency medical technicians should receive well-founded and goal-oriented training enabling them to master the outlined complications. Since adequate first-aid care from other physicians has not been available, there is a need to enlist increasingly the services of specially trained emergency ambulance physicians.
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Plasma renin-activity and plasma aldosterone were measured by radioimmunoassay in 15 female patients before and 16 hours after intraabdominal surgery. Plasma renin was increased in all patients and plasma aldosterone in 12 patients after operation. Plasma renin and plasma aldosterone were correlated significantly (r=0.66, p less than 0.01) in the whole group. ⋯ It is proposed that postoperative hyperaldosteronism is at least partly mediated through the renin-angiotensin-system. An absolute or relative sodium deficit appears to be an unlikely explanation for the stimulation of the renin-angiotensin-system in the postoperative period. The postoperative increase of plasma renin and consequently plasma aldosterone is possibly a consequence of anaesthetic induced impaired kidney perfusion and/or catecholamine mediated stimulation of renin release.
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In 8 volume expanded dogs with an equilibrium between input and renal output of sodium and water neuroleptanalgesia of 6 hours duration with a total of 9 mg/kg of droperidol and 0.35 mg/kg of fentanyl was performed. Under anaesthesia GFR was increased by about 10% (p less than 0,02) compared with the conscious state, whilst renal sodium and water excretion was reduced by about 50%. From this we conclude that active tubular transport of sodium is augmented under neuroleptanalgesia. ⋯ Plasma volume and intravascular protein did not change under neuroleptanalgesia compared with the conscious state. Urine osmolality and negative free water clearance (TcH2O) increased by about 60% under droperidol and fentanyl. In volume expanded dogs under neuroleptanalgesia intravenous application of 0.5-1.0 mg of atropine resulted in a temporary water diuresis.
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Randomized Controlled Trial Clinical Trial
[Epinephrine injection with enflurane anaesthesia: incidence of cardiac arrhythmias (author's transl)].
Two hundred patients, primarily A. S. A. status I and II, were prospectively divided into two groups of 100 each. ⋯ Epinephrine dosages were limited to those recommended for safe use with halothane anaesthesia. No patient in the control group experienced an arrhythmia, and only one patient in the study group developed a burst of premature ventricular contractions following adrenaline injection. The authors conclude that adrenaline may be given subcutaneously for hemostasis in patients under enflurane anaesthesia provided the safeguards established for halothane are observed.
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A report is given on 170 orthopedic operations performed under hemi-spinal anaesthesia. The anaesthetic agent used was hyperbaric bupivacaine 1% (Marcaine, Carbostesine). Of these cases 92 were total hip joint replacements and 78 other operations of the lower extremities. ⋯ The anaesthetics and postoperative courses were smooth. In the total prosthetic hip joint operations hypotension during the implantation of acelabulum--or femur--cement was not observed. With doses of 1 ml of the local anaesthetic the average duration of analgesia was 3 hours and 10 minutes, and with added vasoconstrictor 4 hours.