Anaesthesiologie und Reanimation
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With the combination of a noninvasive saturation measurement and plethysmography, pulse oximetry has become an important monitoring method for peripheral perfusion and oxygen supply. Indications for pulse oximetry is practically every anaesthesia especially in geriatric patients and patients with one-lung-anaesthesia, obesity, asthma and emphysema. Pulse oximetry has proved its worth in the transport of emergency patients. ⋯ Accuracy of response of most currently available pulse oximeters lies between 2-3% (SD) with oxygen saturations between 80-100%. Deviations increase at lower oxygen saturations. Pulse oximetry will soon be regarded as minimal monitoring standard worldwide together with the ECG, blood pressure, pulse and respiratory monitoring.
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Anaesthesiol Reanim · Jan 1991
Review Comparative Study Clinical Trial Controlled Clinical TrialCardiac dysrhythmias during dental surgery. Comparison of hyoscine, glycopyrrolate and placebo premedication.
The incidence of cardiac dysrhythmias was investigated in 60 patients undergoing dental operations under halothane anaesthesia following either hyoscine, glycopyrrolate or placebo as a supplement to nalbuphine for premedication. Forty-five percent of the patients given 6 micrograms/kg hyoscine exhibited cardiac dysrhythmias compared to 25 percent of the group given 4 micrograms/kg glycopyrrolate and to 5 percent in the placebo group. ⋯ There was neither a connection between the frequency of cardiac dysrhythmias and the demographic characteristics of the patients nor with their PaCO2. The author recommends to avoid premedication with anticholinergic combined with halothane anaesthesia with spontaneous respiration during dental operations.
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Anaesthesiol Reanim · Jan 1991
Historical Article[Anesthesiology and intensive therapy 25 years ago--reflections of a new specialty in medical periodicals].
In the search for scientific publications on anaesthesiology and intensive therapy in the year the medical scientific association in the GDR was founded, four periodicals from 1964 were analysed: Das Deutsche Gesundheitswesen, Zeitschrift für Arztliche Fortbildung, Zentralblatt für Gynäkologie and Zentralblatt für Chirurgie. Fifty-six articles were found, half of them written by full-time anaesthetists. These articles give an impression of aspects of pain relief, intensive care and emergency medicine under conditions 25 years ago.
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Anaesthesiol Reanim · Jan 1991
[Reasons for the persistent lethality of malignant hyperthermia and recommendations for its reduction].
Dantrolene is the only known specific treatment of malignant hyperthermia (MH). Following official approval an intravenous formulation of dantrolene became clinically available for emergency treatment of MH. At that time it had been anticipated, that with dantrolene therapy combined with constant vigilance each case of MH could be treated successfully and the mortality rate should be close to zero. ⋯ Administration of an insufficient amount of dantrolene and delayed start of specific therapy due to failure to have immediate access to intravenous dantrolene. 4. Failure to increase minute ventilation immediately after making the diagnosis to meet elevated metabolic demands. A recommendation is presented how to diagnose, to treat and prevent MH, considering present day diagnostic and therapeutic measures in the presence of the presumptive diagnosis of MH.
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Anaesthesiol Reanim · Jan 1991
ReviewPain control with intrathecally and peridurally administered opioids and other drugs.
Sharp pain is conducted rapidly by myelinated delta A fibers and diffused pain slowly by nonmyelinated C fibers to pseudobipolar neurons in the posterior ganglion and from there to neurons located in the posterolateral horn of the spinal cord. From here on nociferous impulses are transmitted by excitatory peptides (e.g. substance P) or amino acids (e.g. glutamate, aspartate) through interconnecting neurons of the pain pathways, primarily on the contralateral side, to the brain stem and from there to the sensory cortex, where they are appreciated and acted upon. There are specific inhibitory receptors located on axon terminals, near to the release sites of the excitatory amino acids and peptides. ⋯ Several different approaches are being investigated for the production of selective spinal analgesia without side effects. They include: a. the use of more lipophilic, long-lasting opioids (e.g. lofentanil) which would be almost completely absorbed by the spinal cord and therefore would not reach the medullary centers; b. the development of opioids with specific affinity to kappa- and for delta- and little or no affinity to mu-receptors, primarily responsible for side effects; and c. combining lower doses of opioid agonists with alpha 2-adrenergic agonists (e.g. clonidine) or with somatostatin. It is conceivable that in the not-too-distant future, it will be possible to achieve through these measures, selective spinal analgesia without side effects.