Anaesthesiologie und Reanimation
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Anaesthesiol Reanim · Jan 1989
Randomized Controlled Trial Clinical Trial[A clinical study of selective gut decolonization in 204 long-term ventilated intensive care patients undergoing abdominal and accident surgery].
In a randomized clinical trial the effects of selective digestive decolonization (SDD) on the frequency of pneumonia and sepsis and the rate of lethality as well as the resistance quota and colonization of bacteria were studied in 102 surgical ICU-patients requiring prolonged mechanical ventilation. These patients received non-resorbable antibiotics: 4 x 100 mg of polymyxin B, 4 x 500 mg of amphotericin B, and 4 x 80 mg of tobramycin via gastric tube. One hundred and two patients served as controls. ⋯ A secondary colonization of the oropharynx in patients of the SDD-group could not be observed. 38.8% of the patients in the control group showed potentially pathogenic microorganisms in oropharyngeal swabs. A development of resistance of pseudomonas aeruginosa against tobramycin occurred in 2.3% of the patients in the SDD-group and in 3.1% of the patients in the control group. It can be concluded that the administration of non-resorbable antimicrobials against gram-negative aerobes is an effective method for prevention of potentially fatal pneumonia and sepsis, and for the first time a significant improvement of the survival rate could be demonstrated.
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Anaesthesiol Reanim · Jan 1989
[Experiences with sacral anesthesia in combination with morphine analgesia].
Sacral anaesthesia is an anaesthetic method which is easy to learn, has a low complication rate and can be used also in elderly patients. The application of long-lasting local anaesthetics like bupivacaine in combination with morphine provides good conditions for postoperative pain relief following proctological operations. ⋯ The mean value of postoperative pain relief amounts to 53 +/- 23.4 hours in patients given sacral anaesthesia with 2 mg/kg bupivacaine with adrenaline 0.005% and 5 mg morphine. Our results are based on 513 patients of whom 105 were given sacral anaesthesia without morphine and 308 with morphine.
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Based on early references a survey on old local anaesthetic drugs and their present position is given: procaine, chloroprocaine, tetracaine, amylocaine, stovaine and dibucaine. Furthermore, the historical development of various local anaesthetic methods as well as their influence by modern technical advances and by modern local anaesthetic drugs is pointed out. Finally an outlook on the present position of regional anaesthetic procedures in newborns, infants and children is given.
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Anaesthesiol Reanim · Jan 1989
[Experiences with a combined sciatic and femoral block in surgery of injuries of the lower leg].
Besides various methods of general anaesthesia, regional anaesthetic procedures are well suited for the surgical care of traumatological patients. For operations on patients with lesions of the lower leg, we have been using for 3 years a combination of dorsolateral blockade of the sciatic nerve according to Winnie with a "3 in 1-block". ⋯ Partial or complete failures were registered in 12% of the cases. Severe complications did not occur.
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Anaesthesiol Reanim · Jan 1989
Comparative Study[A comparison between high-frequency jet ventilation (HFJV) and conventional positive end-expiratory pressure ventilation (CPPV)--an experimental study on dogs with acute lung damage].
In a controlled study on 24 dogs with severe damage to the lungs HFJV was compared to CPPV on the basis of selected cardiorespiratory parameters. The pulmonary damage was produced by injection of oleic acid (OA) into the right atrium under conventional mechanical ventilation (IPPV). After the damage, the dogs were randomly allotted into one of two groups. ⋯ After changeover to HFJV, there is first a further fall of PaO2 from 11.1. +/- 3.0 kPa to 9.1 +/- 1.4 kPa following OA, then, however, until the end of the experiment, a continuous elevation to 15.6 +/- 2.4 kPa with a mean airway pressure that is by 75% lower. The haemodynamic parameters show no significant changes as compared to the initial values, overall, however, they lie significantly below or above those of group I. The results from our investigations allow to draw the conclusion that, despite haemodynamic advantages, HFJV in consequence of deterioration of the arterial oxygenation currently is no alternative superior to CPPV in ventilating the severely damaged lung.