Anaesthesiologie und Reanimation
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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.
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Anaesthesiol Reanim · Jan 1991
Historical Article[The history of the Society for Anesthesiology and Intensive Therapy of the DDR].
In 1960 the first joined meeting of East German anaesthetists took place and in 1964 the "Society of Anaesthesiology and Intensive Therapy of the German Democratic Republic" was founded. Up to its dissolution 26 years later and the 23rd of October 1990, ten congresses with international participation, 10 workshops an 5 bilateral symposia were held. The activities of the board were supplemented by 11 special working-groups. ⋯ In 1989 the "Society of Anaesthesiology and Intensive Therapy of the German Democratic Republic" hat 2,201 members including 1,327 anaesthetists. The former members of the "Society of Anaesthesiology and Intensive Therapy of the German Democratic Republic" are now joining the "German Society of Anaesthesiology and Intensive Medicine". As far as future activities are concerned, the traditional relations with the East European neighbour societies should be given special attention.
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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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The postoperative care of patients usually is characterized by the fact that the individual need of pain killers is not sufficiently recognized. An opioid given only when asked for, results in an underdosage as the patient does not receive the analgesic in time, so that he suffers pain. As there is insufficient knowledge with regard to the pharmacology of opioids which can be used for postoperative pain therapy, physicians and nurses usually tend to give a lower dose in order to avoid any possible side-effects. ⋯ Piritramide has a fast onset of action, 2-5 minutes after intravenous injection and a peak action after 10 minutes. In comparison to pethidine it has no cardiovascular effects, in particular no myocardial depression or increased myocardial oxygen demand (MVO2). Last but not least, the cost-effectiveness is a financial factor of increasing importance to the institution that runs the hospital.
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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.